Wenshuai Fan,1,2,* Yuheng Chen,1,* Tianyao Zhou,1 Yun Xu,3,4 Yutong Gu1,4 

1Department of Orthopaedic Surgery, Zhongshan Hospital Fudan University, Shanghai, People’s Republic of China; 2Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Centre for Rehabilitation Medicine, Department of Pain Management, Zhejiang Provincial People’s Hospital, Zhejiang, People’s Republic of China; 4Shanghai Southwest Spine Surgery Center, Shanghai, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yutong Gu, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China, Email 447574313@qq.com Yun Xu, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China, Email xuyun65204@163.com

Purpose: The purpose of this study is to compare clinical outcomes of obese patients with lumbar degenerative disease (LDD) receiving either percutaneous transforaminal endoscopic surgery (PTES) or minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF).
Methods: There were 26 patients underwent PTES, and 29 patients were treated with MIS-TLIF between June 2014 and June 2019. Various factors were compared between the two groups, including operation time, blood loss, incision length, fluoroscopy frequency, and hospital stay. Visual analog scale (VAS) pain scores, Oswestry disability index (ODI), and complications were also recorded.
Results: Patients in PTES group showed significantly shorter operation time (54± 10min vs 103± 18min, P< 0.001), lower blood loss (5/2-15mL vs 60/40-100mL, P< 0.001), shorter incision length (9± 2mm vs 41± 3mm, P< 0.001), reduced fluoroscopy frequency (5/5-10 times vs 7/6-11 times, P< 0.001) and shorter hospital stay (3/2-4 days vs 6/4-8 days, P< 0.001) than MIS-TLIF group. No differences in leg VAS scores were found between the two groups. However, PTES group showed significantly lower back VAS scores during follow-ups (P< 0.001). At 2-year follow-up, PTES group also had significantly lower ODI scores compared to MIS-TLIF group (12.0± 3.6% vs 15.8± 4.9%, P< 0.01).
Conclusion: PTES and MIS-TLIF showed favorable clinical outcomes for LDD in obese patients. Compared with MIS-TLIF, PTES has advantages of less trauma and faster recovery, and can be conducted under local anesthesia.

Keywords: lumbar degenerative disease, PTES, MIS-TLIF, obesity, minimally invasive surgery