Abstract

Purpose: Morbid obesity is characterized by an individual weighing more than 100 pounds over his or her ideal body weight, or having a body mass index (BMI) of 40 or higher. Approximately 5 percent of Americans are morbidly obese. The morbidly obese surgical patient poses many unusual surgical/anatomical challenges during endoscopic laser minimally invasive spine surgery (MISS), and has a greater incidence of spinal surgical complications, up to 36% in spinal surgery, including problems with wound healing, pneumonia, deep vein thrombosis and need for further surgery. Other adverse outcomes and co-morbidities can include diabetes, kidney failure, hypertension, heart disease, liver disease, and nerve compressions. Newly developed GPS (grid positional systems) for MISS was designed to simplify and facilitate the endoscopic MISS, and microdecompressive spinal discectomy, especially for the morbidly obese. Materials and Methods: Since 1995, 156 morbidly obese surgical patients with 254 symptomatic herniated lumbar discs underwent endoscopic MISS. Average age of 42 (20 to 67) with intraticable single and multiple lumbar herniated discs. Each failed at least 12 weeks of conservative treatment. They were safely treated with outpatient endoscopic laser MISS, guided and facilitate by application and utilization of newly developed GPS. Various endoscopic assisted tubular retractors, dilators, curettes, drills, flexible cutting forceps, saw-toothed trephines, and laser probes are utilized to perform transforaminal and posteromedial endoscopic lumbar microdecompressive discectomy and foraminoplasty for treatment of spinal stenosis. Holmium YAG laser is also applied for laser thermodiskoplasty. Results: Overall result: 140 patients (90%) with good to excellent results. Fair results in 10 patients (6.4%), (with single level problem). For these 156 morbid obese patients, average follow-up, is 46 months (7-48 months). For single level, average satisfaction score is 93%, 145 patients. 11 patients 7% had mild residual pain and paresthesia, although overall their pain lessened. Complication rate is less than 1%. Average return to work is ten days Conclusion: Endoscopic laser MISS, performed with GPS guidance, for microdecompressive lumbar discectomy and stenosis decompression in the morbidly obese surgical patient, is an effective, safe, less traumatic and easier spinal surgery. It avoids the more dangerous alternative of more traumatic open spinal procedures performed with general anesthesia. This less traumatic outpatient procedure reduces risk and complication, and leads to an excellent surgical result, faster recovery and significant economic savings. REFERENCES 1.Chiu, J. 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