No Differences in Post-Operative Recovery Across BMI Following Endoscopic Lumbar Decompression: A Comparative Analysis of Surgical Risk

Introduction: Endoscopic spine surgery is emerging as a frontier in minimally invasive spine surgery, offering shorter recovery periods and reduced postoperative pain by minimizing tissue damage. Discectomy is one of the most common procedures performed endoscopically, with evidence supporting comparable decompression outcomes to open procedures. However, the impact of obesity on outcomes in endoscopic spine surgery remains relatively underexplored. This study investigated whether obesity affects postoperative outcomes following endoscopic lumbar decompression surgery.

Methods: This retrospective study analyzed 110 consecutive patients who underwent transforaminal or interlaminar endoscopic lumbar decompression by a single surgeon between 2019 and 2023 at a multi-hospital academic center. Patients were stratified by body mass index (BMI), with 39 classified as obese (BMI > 30 kg/m²) and 71 as non-obese (BMI ≤ 30 kg/m²). Primary outcomes included postoperative patient-reported outcomes (PROs) such as Visual Analog Scale (VAS), PROMIS Physical Function (PF), PROMIS Pain Interference (PI), and PROMIS Depression, as well as EQ5D. Secondary outcomes were intraoperative complications (e.g., CSF leaks, nerve injury, wound infection), length of stay (LOS), and reoperation rates. Propensity-scored stabilized inverse probability weighting (PS-SIPTW) was used to balance baseline characteristics between groups, and p-values were adjusted for multiplicity using the Benjamini-Hochberg correction.

Results: Among the 110 patients, no significant differences were observed in postoperative PROs between obese and non-obese cohorts across all metrics (adjusted p-values > 0.05). The mean length of stay was 0.50 ± 1.34 days for obese patients and 0.60 ± 1.58 days for non-obese patients (MD -0.1 days, 95% CI -0.7 to 0.5 days, p = 0.730). Total surgical time also did not differ significantly between the two groups. There were no significant differences in intraoperative complications, including CSF leaks, nerve injury, or wound infection, nor were there significant differences in reoperation rates.

Conclusion : This study found no significant differences in postoperative patient-reported outcomes, complications, or reoperation rates between obese and non-obese patients following endoscopic lumbar decompression. These results suggest that obesity does not negatively impact outcomes in endoscopic spine surgery, and an endoscopic approach may help mitigate surgical risks associated with obesity. Future studies with larger cohorts are needed to further elucidate these findings.