title: Posterior lumbar spinal fusion and instrumentation in morbidly obese patients using the Synframe retractor system: technical note.
abstract: OBJECTIVE
  Lumbar spine surgery in morbidly obese patients is a challenge to the operating surgeon. The aim of the study was to evaluate the surgical experience in this group of patients using the Synframe retractor system (Synthes, Paoli, PA, USA) as a tool for improved surgical access.
  
  
  METHODS
  An Institutional Review Board approved retrospective study was conducted on 43 morbidly obese patients undergoing posterior lumbar decompression instrumentation and fusion. Patient selection was based on a BMI of >40. Information acquired included BMI, set up time, procedure time, ASA, intraoperative blood loss and the number of preoperative co-morbidities of each patient. Postoperative complications, length of stay, and pre-operative and postoperative Oswestry disability index (ODI) and visual analogue scale (VAS) were recorded at each postoperative visit. They were compared to 45 age matched controls from our spine database.
  
  
  RESULTS
  The average set-up time (73.5 min), amount of blood loss (average 1,040 mL), length of incision (10.3-14.5 cm) and length of hospital stay (5.4 days) were recorded. The average surgical time was dependent on the procedure and number of levels fused and ranged from 164 to 245 min. These parameters were compared with normal weight patients and noted to be higher.
  
  
  CONCLUSIONS
  The surgical experience determined that the Synframe retractor system provided a stable and well-illuminated operative field. It minimized the number of personnel required for assistance and improved surgical access. As may be expected, all the above recorded parameters were greater in the morbidly obese group.
authors.affiliation: Department of Orthopaedic Surgery, Detriot Medical Center, Detroit Receiving Hospital, 4D-4 UHC, 4201 St. Antoine Street, Detroit, MI 48201, USA. RahVaidya@hotmail.com
authors.forename: Rahul
authors.initials: R
authors.lastname: Vaidya
authors.forename: Anil
authors.initials: A
authors.lastname: Sethi
authors.forename: Adrienne
authors.initials: A
authors.lastname: Lee
authors.forename: Steve
authors.initials: S
authors.lastname: Bartol
authors.forename: Ndidi
authors.initials: N
authors.lastname: Onwudiwe
authors.forename: Max
authors.initials: M
authors.lastname: Aebi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D010147:Pain Measurement; D011183:Postoperative Complications; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*