gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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5-year follow-up show less infection rate and muscle damage by MIS spondylodesis in very obese patients (BMI > 35)

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  • T. Pfandlsteiner - Klinik für Wirbelsäulenchirurgie mit Skoliosezentrum, Schön-Klinik Vogtareuth, Lehrabteilung der PMU Salzburg, Deutschland
  • K. Seidel - Klinik für Wirbelsäulenchirurgie mit Skoliosezentrum, Schön-Klinik Vogtareuth, Lehrabteilung der PMU Salzburg, Deutschland
  • C. Wimmer - Klinik für Wirbelsäulenchirurgie mit Skoliosezentrum, Schön-Klinik Vogtareuth, Lehrabteilung der PMU Salzburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.08.05

doi: 10.3205/12dgnc071, urn:nbn:de:0183-12dgnc0715

Published: June 4, 2012

© 2012 Pfandlsteiner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: Obesity and degenerative lumbar scoliosis is often combined with muscular insufficiency. Muscle damage during operation is a problem in obese patients. Muscle weakness and infection rate of the percutaneous minimal invasive stabilization (MIS group II) versus the open stabilization (group I). Muscle damage is much less by the lower rate of damage of the Rami dorsales in the MIS Surgery.

Methods: Retrospective study, 06/2006–10/2011. T– Score < –2,3, group I: 96 and group II: 92 patients. Age at operation was 55,4a, BMI 39. VAS and patient satisfaction score have been done. Indication: Degenerative scoliosis, osteochondrosis, spondylolisthesis and FBSS. Deep and superficial infection with bacterial spectrum has been determined. All deep infections have been treated with wide debridement, jet lavage, drainage, parenteral antibiotics (AB) 7 to 10 days with antibiogramm. The superficial infections have been treated after revision 3 days with parenteral then with oral AB. Fusion was controlled by x-Ray or CT-scan after 6, 12, 24 MO and pain threshold was measured by a digital dolorimeter at defined trigger points before and 6, 12 and 24 MO after operation.

Results: Fusion rate in the dorsal group was 85% (group I and II) and in the dorsoventral group 92%. Follow-up 36 (22–60) MO, lost to follow-up 1/96 and 0/92. Screw loosening combined with pseudoarthrosis in group I in 7 patients and in group II in 2 patients, adjacent disc degeneration in group I 7/96 and in group II 1/92, screw breakage in group I 1/96 and in group II 0. The length of walking distance improved in the MIS group 3 months earlier. Trigger point measurement showed a decrease from pre OP 1,8 (0,7–2,2) kg/cm2 to 2,3 (1,6–3,8) kg/cm2 6 MO OP and 4,6 (3,0–6,7) kg/cm2 12 MO post OP. At least control 24 MO post OP they were 5,5 (4,6–8,9) kg/cm2. The patient satisfaction score was much better in the MIS group, and the VAS score decreased significant earlier. 2.46% deep and 1.76% superficial infections have been evaluated in group I. No infection in the MIS group.

Conclusions: The pre OP existing muscular insufficiency in obese patients is not that much increased in the MIS group than in the conventional group after operation. Rate of adjacent disc degeneration, infection rate and screw loosening is significant much lower in the MIS group. Minimal invasive, percutaneous instrumentation shows advantages especially in obese patients.