Asian Spine J.
2025 Apr;19(2):292-310. 10.31616/asj.2024.0376.
Endoscopic spine surgery for obesity-related surgical challenges: a systematic review and meta-analysis of current evidence
- Liawrungrueang W
1 - Cholamjiak W2
- Sarasombath P3
- Sakti YM4
- Wu PH5
- Wu MH6,7,8
- Lu YJ9
- Yau LC10
- Ito Z11
- Cho ST12
- Chang DG13
- Lim KT14
- Affiliations
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- 1Department of Orthopaedics, School of Medicine, University of Phayao, Phayao, Thailand
- 2Department of Mathematics, School of Science, University of Phayao, Phayao, Thailand
- 3Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
- 4Orthopedics and Traumatology Department, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- 5Achieve Spine and Orthopaedic Centre, Mount Elizabeth Hospital, Singapore
- 6Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
- 7Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- 8Prospective Innovation Center, Taipei Medical University Hospital, Taipei, Taiwan
- 9Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- 10Department of Orthopaedics and Traumatology, North District Hospital, University of Hong Kong, Hong Kong
- 11Department of Orthopaedics, Aichi Spine Hospital, Nagoya, Japan
- 12Department of Orthopedic Surgery, Seoul Seonam Hospital, Seoul, Korea
- 13Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
- 14Department of Neurosurgery, AIN Hospital, Incheon, Korea
- KMID: 2567403
- DOI: http://doi.org/10.31616/asj.2024.0376
Abstract
- Obesity presents significant challenges in spinal surgery, including higher rates of perioperative complications, prolonged operative times, and delayed recovery. Traditional open spine surgery often exacerbates these risks, particularly in patients with obesity, because of extensive tissue dissection and larger incisions. Endoscopic spine surgery (ESS) has emerged as a promising minimally invasive alternative, offering advantages such as reduced tissue trauma, minimal blood loss, lower infection rates, and faster recovery. This systematic review and meta-analysis aimed to evaluate the safety, efficacy, and outcomes of ESS techniques, including fully endoscopic and biportal endoscopic lumbar discectomy and decompression, in patients with obesity and lumbar spine pathologies. A comprehensive literature search of the PubMed/Medline, Embase, and Scopus databases yielded 2,975 studies published between 2000 and 2024, of which 10 met the inclusion criteria. The meta-analysis revealed significant improvements in pain relief (Visual Analog Scale) and functional outcomes (Oswestry Disability Index), with comparable results between patients with and without obesity. Patients who are obese experienced longer operative times and have a slightly higher risk of symptom recurrence; however, ESS demonstrated lower rates of wound infections, shorter hospital stays, and faster recovery than traditional surgery. These findings position ESS as a viable and effective option for managing lumbar spine conditions in patients with obesity, addressing obesity-related surgical challenges while maintaining favorable clinical outcomes. However, limitations such as study heterogeneity and the lack of randomized controlled trials highlight the need for further high-quality research to refine ESS techniques and optimize patient care in this high-risk population.
