Minimal Outcome Disparities exist between Obese and Non-Obese Patients after Endoscopic Decompression Surgery

Introduction: Obesity is a well-established risk factor contributing to poor postoperative outcomes. The deleterious obesity-associated effects in the context of spinal surgery may be attributed to various medical comorbidities frequently associated with obesity, or to the increased adipose volume traversed during surgical approaches. Endoscopic spine surgery represents a minimally invasive technique that may mitigating the adverse impact of body habitus on patient outcomes. To this end, we conducted a comparative analysis of clinical outcomes in patients with BMI > 30 vs. BMI < 30 who underwent lumbar decompression utilizing endoscopic techniques.

Methods: All patients who underwent single-level lumbar nerve root decompression between 2019 and 2023 at a multi-hospital academic center with endoscopic and open approaches were identified. Each patient’s demographics, surgical time, length-of-stay (LOS), Charlson comorbidity index (CCI), operative time, and patient-reported outcome measures (PROMs) were collected. Student’s t-tests were used to compare differences in outcome metrics while accounting for demographic differences.

Results: A total of 110 patients (71 non-obese and 39 obese) were included in the study. Non-obese patients exhibited a significant gain in PROMIS PF scores (3.39 vs. -1.5, p=0.047). Differences in PROMIS PI, PROMIS Depression, EQ5D, length of stay, reoperation rates, CSF leaks, and nerve injury were not statistically significant. There were no instances of infection or wound complications in either group.

Conclusion : Our analysis challenges the prevailing notion that obesity adversely affects endoscopic nerve decompression outcomes for lumbar radiculopathy. Notably, the only significant difference was improved physical function in nonobese patients. The negligible differences in other metrics suggest that endoscopic techniques could neutralize increased risks traditionally linked with obesity. Our results emphasize the need for personalized perioperative strategies, particularly for obese patients, to optimize recovery. Our study supports the broader application of endoscopic approaches in spinal surgery, advocating that patient weight should not deter selecting minimally invasive procedures.