Research progress in effect of obesity on the effectiveness of posterior lumbar fusion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Yuzhu ,  WANG Yuntao , JIANG Feng , ZHANG Bin

Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P.R.China;

Corresponding author：

WANG Yuntao, Email: wangyttod@aliyun.com

Keywords：

Obesity; lumbar degenerative disease; posterior lumbar fusion; complication

DOI：

10.7507/1002-1892.202004144

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To review the effect of obesity on the effectiveness of posterior lumbar fusion in patients with lumbar degenerative diseases (LDD).Methods The related literature at home and abroad was extensively reviewed. And the difficulty of operation, risk of complications, and long-term effectiveness of posterior lumbar fusion for obese patients with LDD were summarized.Results Although some relevant literature suggest that the posterior lumbar fusion for obese patients is difficult and the risk of postoperative complications is high, the overall research results do not suggest that obesity is a risk factor for the implementation of posterior lumbar fusion. By assessing the physical condition of patients and strictly grasping the surgical indications, obese patients can obtain good surgical efficacy.Conclusion Posterior lumbar fusion is an effective method for the treatment of LDD in obese patients. However, relevant studies need to be completed to further evaluate the safety and efficacy of posterior lumbar fusion for obese patients.

Citation： XU Yuzhu, WANG Yuntao, JIANG Feng, ZHANG Bin. Research progress in effect of obesity on the effectiveness of posterior lumbar fusion. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(1): 130-136. doi: 10.7507/1002-1892.202004144 Copy

1.	Shmagel A, Foley R, Ibrahim H. Epidemiology of chronic low back pain in us adults: data from the 2009-2010 national health and nutrition examination survey. Arthritis Care Res (Hoboken), 2016, 68(11): 1688-1694.
2.	Yang S, Liu Y, Bao Z, et al. Comparison of adjacent segment degeneration after nonrigid fixation system and posterior lumbar interbody fusion for single-level lumbar disc herniation: A new method of MRI analysis of lumbar nucleus pulposus volume. J Invest Surg, 2018, 31(4): 307-312.
3.	Gaudelli C, Thomas K. Obesity and early reoperation rate after elective lumbar spine surgery: a population-based study. Evid Based Spine Care J, 2012, 3(2): 11-16.
4.	Lingutla KK, Pollock R, Benomran E, et al. Outcome of lumbar spinal fusion surgery in obese patients: a systematic review and meta-analysis. Bone Joint J, 2015, 97-B(10): 1395-1404.
5.	Apovian CM. Obesity: definition, comorbidities, causes, and burden. Am J Manag Care, 2016, 22(7 Suppl): s176-185.
6.	De Lorenzo A, Soldati L, Sarlo F, et al. New obesity classification criteria as a tool for bariatric surgery indication. World J Gastroenterol, 2016, 22(2): 681-703.
7.	Fletcher I. Defining an epidemic: the body mass index in British and US obesity research 1960-2000. Sociol Health Illn, 2014, 36(3): 338-353.
8.	Djurasovic M, Bratcher KR, Glassman SD, et al. The effect of obesity on clinical outcomes after lumbar fusion. Spine (Phila Pa 1976), 2008, 33(16): 1789-1792.
9.	Furukawa A, Kasai Y, Akeda K, et al. Influence of obesity on outcomes of surgery for lumbar spinal stenosis. The Open Spine Journal, 2010, 2(1): 8-11.
10.	Han IH, Son DW, Nam KH, et al. The effect of body mass index on intra-abdominal pressure and blood loss in lumbar spine surgery. J Korean Neurosurg Soc, 2012, 51(2): 81-85.
11.	Mehta AI, Babu R, Karikari IO, et al. 2012 Young Investigator Award winner: The distribution of body mass as a significant risk factor for lumbar spinal fusion postoperative infections. Spine (Phila Pa 1976), 2012, 37(19): 1652-1656.
12.	Rihn JA, Radcliff K, Hilibrand AS, et al. Does obesity affect outcomes of treatment for lumbar stenosis and degenerative spondylolisthesis? Analysis of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976), 2012, 37(23): 1933-1946.
13.	Erkan S, Ozalp RT, Yercan HS, et al. Obesity reduces fusion rates and clinical outcomes in non-smoker patients undergoing instrumented posterolateral fusions. Eur Spine J, 2013, 22(suppl5): S787-S792.
14.	Knutsson B, Michaëlsson K, Sandén B. Obesity is associated with inferior results after surgery for lumbar spinal stenosis: a study of 2633 patients from the Swedish spine register. Spine (Phila Pa 1976), 2013, 38(5): 435-441.
15.	Pereira BJ, de Holanda CV, Ribeiro CA, et al. Impact of body mass index in spinal surgery for degenerative lumbar spine disease. Clin Neurol Neurosurg, 2014, 127: 112-115.
16.	De la Garza-Ramos R, Bydon M, Abt NB, et al. The impact of obesity on short- and long-term outcomes after lumbar fusion. Spine (Phila Pa 1976), 2015, 40(1): 56-61.
17.	Adogwa O, Farber SH, Fatemi P, et al. Do obese patients have worse outcomes after direct lateral interbody fusion compared to non-obese patients? J Clin Neurosci, 2016, 25: 54-57.
18.	Sorimachi Y, Neva MH, Vihtonen K, et al. Effect of obesity and being overweight on disability and pain after lumbar fusion: An analysis of 805 patients. Spine (Phila Pa 1976), 2016, 41(9): 772-777.
19.	Onyekwelu I, Glassman SD, Asher AL, et al. Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery. J Neurosurg Spine, 2017, 26(2): 158-162.
20.	Gokcen HB, Ozturk C. Does obesity make transforaminal lumbar interbody fusion more difficult: A retrospective analysis. Cureus, 2018, 10(12): e3762.
21.	Zhang Y, Zhang J, Liu H, et al. Impact of obesity on restoration of sagittal balance and clinical efficacy after posterior lumbar interbody fusion. J Clin Neurosci, 2019, 69: 170-174.
22.	Khan JM, Basques BA, Kunze KN, et al. Does obesity impact lumbar sagittal alignment and clinical outcomes after a posterior lumbar spine fusion? Eur Spine J, 2020, 29(2): 340-348.
23.	Divi SN, Goyal DKC, Galetta MS, et al. How does body mass index influence outcomes in patients after lumbar fusion? Spine (Phila Pa 1976), 2020, 45(8): 555-561.
24.	Williams EP, Mesidor M, Winters K, et al. Overweight and obesity: Prevalence, consequences, and causes of a growing public health problem. Curr Obes Rep, 2015, 4(3): 363-370.
25.	孙英飞, 石东平, 张启栋, 等. 不同 BMI 单节段腰椎退行性病变患者经腰椎后路 360° 融合术治疗效果及预后对比. 中华全科医学, 2019, 17(6): 902-905.
26.	Abbasi H, Grant A. Effect of body mass index on perioperative outcomes in minimally invasive oblique lateral lumbar interbody fusion versus open fusions: A multivariant analysis. Cureus, 2018, 10(3): e2288.
27.	Jiang J, Teng Y, Fan Z, et al. Does obesity affect the surgical outcome and complication rates of spinal surgery? A meta-analysis. Clin Orthop Relat Res, 2014, 472(3): 968-975.
28.	Chang MY, Park Y, Ha JW, et al. Paraspinal lean muscle mass measurement using spine MRI as a predictor of adjacent segment disease after lumbar fusion: A propensity score-matched case-control analysis. AJR Am J Roentgenol, 2019, 212(6): 1-8.
29.	许立臣, 许卫兵, 杨东方, 等. 椎间孔入路腰椎间融合内固定治疗腰椎间盘退行性疾病: 患者体重指数与翻修率的关系. 中国组织工程研究, 2018, 22(19): 2994-2999.
30.	Ranson WA, Cheung ZB, Di Capua J, et al. Risk factors for perioperative complications in morbidly obese patients undergoing elective posterior lumbar fusion. Global Spine J, 2018, 8(8): 795-802.
31.	Buerba RA, Fu MC, Gruskay JA, et al. Obese Class Ⅲ patients at significantly greater risk of multiple complications after lumbar surgery: an analysis of 10, 387 patients in the ACS NSQIP database. Spine J, 2014, 14(9): 2008-2018.
32.	Zhang HC, Yu HL, Yang HF, et al. Short-segment decompre-ssion/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type Ⅵ adult degenerative scoliosis. Chin Med J (Engl), 2019, 132(21): 2543-2549.
33.	Vaidya R, Carp J, Bartol S, et al. Lumbar spine fusion in obese and morbidly obese patients. Spine (Phila Pa 1976), 2009, 34(5): 495-500.
34.	Kalanithi PA, Arrigo R, Boakye M. Morbid obesity increases cost and complication rates in spinal arthrodesis. Spine (Phila Pa 1976), 2012, 37(11): 982-988.
35.	Ye IB, Tang R, Schwartz JT, et al. Postoperative complications associated with metabolic syndrome following adult spinal deformity surgery. Clin Spine Surg, 2020, 33(2): E87-E91.
36.	Bono OJ, Poorman GW, Foster N, et al. Body mass index predicts risk of complications in lumbar spine surgery based on surgical invasiveness. Spine J, 2018, 18(7): 1204-1210.
37.	Cao J, Kong L, Meng F, et al. Impact of obesity on lumbar spinal surgery outcomes. J Clin Neurosci, 2016, 28: 1-6.
38.	Keorochana G, Setrkraising K, Woratanarat P, et al. Clinical outcomes after minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion for treatment of degenerative lumbar disease: a systematic review and meta-analysis. Neurosurg Rev, 2018, 41(3): 755-770.
39.	吴国勇, 罗德军, 戢勇, 等. 肥胖对 MIS-TLIF 手术治疗腰椎管狭窄症的疗效影响. 颈腰痛杂志, 2018, 39(6): 735-737.
40.	Burks CA, Werner BC, Yang S, et al. Obesity is associated with an increased rate of incidental durotomy in lumbar spine surgery. Spine (Phila Pa 1976), 2015, 40(7): 500-504.
41.	McGuire KJ, Khaleel MA, Rihn JA, et al. The effect of high obesity on outcomes of treatment for lumbar spinal conditions: subgroup analysis of the spine patient outcomes research trial. Spine (Phila Pa 1976), 2014, 39(23): 1975-1980.
42.	Murphy ME, Kerezoudis P, Alvi MA, et al. Risk factors for dural tears: a study of elective spine surgery. Neurol Res, 2017, 39(2): 97-106.
43.	Yamada K, Abe Y, Satoh S, et al. Large increase in blood pressure after extubation and high body mass index elevate the risk of spinal epidural hematoma after spinal surgery. Spine (Phila Pa 1976), 2015, 40(13): 1046-1052.
44.	Fujiwara Y, Manabe H, Izumi B, et al. The impact of hypertension on the occurrence of postoperative spinal epidural hematoma following single level microscopic posterior lumbar decompression surgery in a single institute. Eur Spine J, 2017, 26(10): 2606-2615.
45.	Kao FC, Tsai TT, Chen LH, et al. Symptomatic epidural hematoma after lumbar decompression surgery. Eur Spine J, 2015, 24(2): 348-357.
46.	Chaichana KL, Bydon M, Santiago-Dieppa DR, et al. Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases. J Neurosurg Spine, 2014, 20(1): 45-52.
47.	Meredith DS, Kepler CK, Huang RC, et al. Postoperative infections of the lumbar spine: presentation and management. Int Orthop, 2012, 36(2): 439-444.
48.	Ou CY, Lee TC, Lee TH, et al. Impact of body mass index on adjacent segment disease after lumbar fusion for degenerative spine disease. Neurosurgery, 2015, 76(4): 396-401.
49.	Wang H, Ma L, Yang D, et al. Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders. Medicine (Baltimore), 2017, 96(5): e6032.
50.	Kim JY, Ryu DS, Paik HK, et al. Paraspinal muscle, facet joint, and disc problems: risk factors for adjacent segment degeneration after lumbar fusion. Spine J, 2016, 16(7): 867-875.
51.	Park JS, Shim KD, Song YS, et al. Risk factor analysis of adjacent segment disease requiring surgery after short lumbar fusion: the influence of rheumatoid arthritis. Spine J, 2018, 18(9): 1578-1583.
52.	薛有地, 刘光普, 周恒才, 等. 单侧后正中入路 TLIF 联合对侧肌间隙入路椎弓根钉内固定治疗肥胖患者腰椎管狭窄症. 中国骨与关节损伤杂志, 2018, 33(11): 1187-1189.
53.	孙卓然, 李危石, 郭扬, 等. 腰椎融合术前相邻节段存在退变因素对术后早期临床疗效的影响. 中国修复重建外科杂志, 2019, 33(7): 837-844.
54.	王升儒, 莫家栋, 陈奋勇, 等. 腰椎后路椎间融合术后融合器脱出的原因分析. 中华骨与关节外科杂志, 2019, 12(6): 414-418.

1. Shmagel A, Foley R, Ibrahim H. Epidemiology of chronic low back pain in us adults: data from the 2009-2010 national health and nutrition examination survey. Arthritis Care Res (Hoboken), 2016, 68(11): 1688-1694.
2. Yang S, Liu Y, Bao Z, et al. Comparison of adjacent segment degeneration after nonrigid fixation system and posterior lumbar interbody fusion for single-level lumbar disc herniation: A new method of MRI analysis of lumbar nucleus pulposus volume. J Invest Surg, 2018, 31(4): 307-312.
3. Gaudelli C, Thomas K. Obesity and early reoperation rate after elective lumbar spine surgery: a population-based study. Evid Based Spine Care J, 2012, 3(2): 11-16.
4. Lingutla KK, Pollock R, Benomran E, et al. Outcome of lumbar spinal fusion surgery in obese patients: a systematic review and meta-analysis. Bone Joint J, 2015, 97-B(10): 1395-1404.
5. Apovian CM. Obesity: definition, comorbidities, causes, and burden. Am J Manag Care, 2016, 22(7 Suppl): s176-185.
6. De Lorenzo A, Soldati L, Sarlo F, et al. New obesity classification criteria as a tool for bariatric surgery indication. World J Gastroenterol, 2016, 22(2): 681-703.
7. Fletcher I. Defining an epidemic: the body mass index in British and US obesity research 1960-2000. Sociol Health Illn, 2014, 36(3): 338-353.
8. Djurasovic M, Bratcher KR, Glassman SD, et al. The effect of obesity on clinical outcomes after lumbar fusion. Spine (Phila Pa 1976), 2008, 33(16): 1789-1792.
9. Furukawa A, Kasai Y, Akeda K, et al. Influence of obesity on outcomes of surgery for lumbar spinal stenosis. The Open Spine Journal, 2010, 2(1): 8-11.
10. Han IH, Son DW, Nam KH, et al. The effect of body mass index on intra-abdominal pressure and blood loss in lumbar spine surgery. J Korean Neurosurg Soc, 2012, 51(2): 81-85.
11. Mehta AI, Babu R, Karikari IO, et al. 2012 Young Investigator Award winner: The distribution of body mass as a significant risk factor for lumbar spinal fusion postoperative infections. Spine (Phila Pa 1976), 2012, 37(19): 1652-1656.
12. Rihn JA, Radcliff K, Hilibrand AS, et al. Does obesity affect outcomes of treatment for lumbar stenosis and degenerative spondylolisthesis? Analysis of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976), 2012, 37(23): 1933-1946.
13. Erkan S, Ozalp RT, Yercan HS, et al. Obesity reduces fusion rates and clinical outcomes in non-smoker patients undergoing instrumented posterolateral fusions. Eur Spine J, 2013, 22(suppl5): S787-S792.
14. Knutsson B, Michaëlsson K, Sandén B. Obesity is associated with inferior results after surgery for lumbar spinal stenosis: a study of 2633 patients from the Swedish spine register. Spine (Phila Pa 1976), 2013, 38(5): 435-441.
15. Pereira BJ, de Holanda CV, Ribeiro CA, et al. Impact of body mass index in spinal surgery for degenerative lumbar spine disease. Clin Neurol Neurosurg, 2014, 127: 112-115.
16. De la Garza-Ramos R, Bydon M, Abt NB, et al. The impact of obesity on short- and long-term outcomes after lumbar fusion. Spine (Phila Pa 1976), 2015, 40(1): 56-61.
17. Adogwa O, Farber SH, Fatemi P, et al. Do obese patients have worse outcomes after direct lateral interbody fusion compared to non-obese patients? J Clin Neurosci, 2016, 25: 54-57.
18. Sorimachi Y, Neva MH, Vihtonen K, et al. Effect of obesity and being overweight on disability and pain after lumbar fusion: An analysis of 805 patients. Spine (Phila Pa 1976), 2016, 41(9): 772-777.
19. Onyekwelu I, Glassman SD, Asher AL, et al. Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery. J Neurosurg Spine, 2017, 26(2): 158-162.
20. Gokcen HB, Ozturk C. Does obesity make transforaminal lumbar interbody fusion more difficult: A retrospective analysis. Cureus, 2018, 10(12): e3762.
21. Zhang Y, Zhang J, Liu H, et al. Impact of obesity on restoration of sagittal balance and clinical efficacy after posterior lumbar interbody fusion. J Clin Neurosci, 2019, 69: 170-174.
22. Khan JM, Basques BA, Kunze KN, et al. Does obesity impact lumbar sagittal alignment and clinical outcomes after a posterior lumbar spine fusion? Eur Spine J, 2020, 29(2): 340-348.
23. Divi SN, Goyal DKC, Galetta MS, et al. How does body mass index influence outcomes in patients after lumbar fusion? Spine (Phila Pa 1976), 2020, 45(8): 555-561.
24. Williams EP, Mesidor M, Winters K, et al. Overweight and obesity: Prevalence, consequences, and causes of a growing public health problem. Curr Obes Rep, 2015, 4(3): 363-370.
25. 孙英飞, 石东平, 张启栋, 等. 不同 BMI 单节段腰椎退行性病变患者经腰椎后路 360° 融合术治疗效果及预后对比. 中华全科医学, 2019, 17(6): 902-905.
26. Abbasi H, Grant A. Effect of body mass index on perioperative outcomes in minimally invasive oblique lateral lumbar interbody fusion versus open fusions: A multivariant analysis. Cureus, 2018, 10(3): e2288.
27. Jiang J, Teng Y, Fan Z, et al. Does obesity affect the surgical outcome and complication rates of spinal surgery? A meta-analysis. Clin Orthop Relat Res, 2014, 472(3): 968-975.
28. Chang MY, Park Y, Ha JW, et al. Paraspinal lean muscle mass measurement using spine MRI as a predictor of adjacent segment disease after lumbar fusion: A propensity score-matched case-control analysis. AJR Am J Roentgenol, 2019, 212(6): 1-8.
29. 许立臣, 许卫兵, 杨东方, 等. 椎间孔入路腰椎间融合内固定治疗腰椎间盘退行性疾病: 患者体重指数与翻修率的关系. 中国组织工程研究, 2018, 22(19): 2994-2999.
30. Ranson WA, Cheung ZB, Di Capua J, et al. Risk factors for perioperative complications in morbidly obese patients undergoing elective posterior lumbar fusion. Global Spine J, 2018, 8(8): 795-802.
31. Buerba RA, Fu MC, Gruskay JA, et al. Obese Class Ⅲ patients at significantly greater risk of multiple complications after lumbar surgery: an analysis of 10, 387 patients in the ACS NSQIP database. Spine J, 2014, 14(9): 2008-2018.
32. Zhang HC, Yu HL, Yang HF, et al. Short-segment decompre-ssion/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type Ⅵ adult degenerative scoliosis. Chin Med J (Engl), 2019, 132(21): 2543-2549.
33. Vaidya R, Carp J, Bartol S, et al. Lumbar spine fusion in obese and morbidly obese patients. Spine (Phila Pa 1976), 2009, 34(5): 495-500.
34. Kalanithi PA, Arrigo R, Boakye M. Morbid obesity increases cost and complication rates in spinal arthrodesis. Spine (Phila Pa 1976), 2012, 37(11): 982-988.
35. Ye IB, Tang R, Schwartz JT, et al. Postoperative complications associated with metabolic syndrome following adult spinal deformity surgery. Clin Spine Surg, 2020, 33(2): E87-E91.
36. Bono OJ, Poorman GW, Foster N, et al. Body mass index predicts risk of complications in lumbar spine surgery based on surgical invasiveness. Spine J, 2018, 18(7): 1204-1210.
37. Cao J, Kong L, Meng F, et al. Impact of obesity on lumbar spinal surgery outcomes. J Clin Neurosci, 2016, 28: 1-6.
38. Keorochana G, Setrkraising K, Woratanarat P, et al. Clinical outcomes after minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion for treatment of degenerative lumbar disease: a systematic review and meta-analysis. Neurosurg Rev, 2018, 41(3): 755-770.
39. 吴国勇, 罗德军, 戢勇, 等. 肥胖对 MIS-TLIF 手术治疗腰椎管狭窄症的疗效影响. 颈腰痛杂志, 2018, 39(6): 735-737.
40. Burks CA, Werner BC, Yang S, et al. Obesity is associated with an increased rate of incidental durotomy in lumbar spine surgery. Spine (Phila Pa 1976), 2015, 40(7): 500-504.
41. McGuire KJ, Khaleel MA, Rihn JA, et al. The effect of high obesity on outcomes of treatment for lumbar spinal conditions: subgroup analysis of the spine patient outcomes research trial. Spine (Phila Pa 1976), 2014, 39(23): 1975-1980.
42. Murphy ME, Kerezoudis P, Alvi MA, et al. Risk factors for dural tears: a study of elective spine surgery. Neurol Res, 2017, 39(2): 97-106.
43. Yamada K, Abe Y, Satoh S, et al. Large increase in blood pressure after extubation and high body mass index elevate the risk of spinal epidural hematoma after spinal surgery. Spine (Phila Pa 1976), 2015, 40(13): 1046-1052.
44. Fujiwara Y, Manabe H, Izumi B, et al. The impact of hypertension on the occurrence of postoperative spinal epidural hematoma following single level microscopic posterior lumbar decompression surgery in a single institute. Eur Spine J, 2017, 26(10): 2606-2615.
45. Kao FC, Tsai TT, Chen LH, et al. Symptomatic epidural hematoma after lumbar decompression surgery. Eur Spine J, 2015, 24(2): 348-357.
46. Chaichana KL, Bydon M, Santiago-Dieppa DR, et al. Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases. J Neurosurg Spine, 2014, 20(1): 45-52.
47. Meredith DS, Kepler CK, Huang RC, et al. Postoperative infections of the lumbar spine: presentation and management. Int Orthop, 2012, 36(2): 439-444.
48. Ou CY, Lee TC, Lee TH, et al. Impact of body mass index on adjacent segment disease after lumbar fusion for degenerative spine disease. Neurosurgery, 2015, 76(4): 396-401.
49. Wang H, Ma L, Yang D, et al. Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders. Medicine (Baltimore), 2017, 96(5): e6032.
50. Kim JY, Ryu DS, Paik HK, et al. Paraspinal muscle, facet joint, and disc problems: risk factors for adjacent segment degeneration after lumbar fusion. Spine J, 2016, 16(7): 867-875.
51. Park JS, Shim KD, Song YS, et al. Risk factor analysis of adjacent segment disease requiring surgery after short lumbar fusion: the influence of rheumatoid arthritis. Spine J, 2018, 18(9): 1578-1583.
52. 薛有地, 刘光普, 周恒才, 等. 单侧后正中入路 TLIF 联合对侧肌间隙入路椎弓根钉内固定治疗肥胖患者腰椎管狭窄症. 中国骨与关节损伤杂志, 2018, 33(11): 1187-1189.
53. 孙卓然, 李危石, 郭扬, 等. 腰椎融合术前相邻节段存在退变因素对术后早期临床疗效的影响. 中国修复重建外科杂志, 2019, 33(7): 837-844.
54. 王升儒, 莫家栋, 陈奋勇, 等. 腰椎后路椎间融合术后融合器脱出的原因分析. 中华骨与关节外科杂志, 2019, 12(6): 414-418.

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Chinese Journal of Reparative and Reconstructive Surgery

Research progress in effect of obesity on the effectiveness of posterior lumbar fusion

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