Comparison of perioperative outcomes following open versus minimally invasive transforaminal lumbar interbody fusion in obese patients

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) has proven to be effective in the treatment of spondylolisthesis and degenerative disc disease (DDD). Compared with the traditional open TLIF, the MI procedure has been associated with less blood loss, less postoperative pain, and a shorter hospital stay. However, it is uncertain whether the advantages of an MI TLIF also apply specifically to obese patients. This study was dedicated to evaluating whether obese patients reap the perioperative benefits similar to those seen in patients with normal body mass index (BMI) when undergoing MI TLIF.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Obese patients—that is, those with a BMI of at least 30 kg/m<jats:sup>2</jats:sup>—who had undergone single-level TLIF were retrospectively identified and categorized according to BMI: Class I obesity, BMI 30.0–34.9 kg/m<jats:sup>2</jats:sup>; Class II obesity, BMI 35.0–39.9 kg/m<jats:sup>2</jats:sup>; or Class III obesity, BMI ≥ 40.0 kg/m<jats:sup>2</jats:sup>. In each obesity class, patients were stratified by TLIF approach, that is, open versus MI. Perioperative outcomes, including intraoperative estimated blood loss (EBL), complications (overall, intraoperative, and 30-day postoperative), and hospital length of stay (LOS), were compared. The chi-square test, Fisher exact test, or 2-tailed Student t-test were used when appropriate.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>One hundred twenty-seven patients were included in the final analysis; 49 underwent open TLIF and 78 underwent MI TLIF. Sixty-one patients had Class I obesity (23 open and 38 MI TLIF); 45 patients, Class II (19 open and 26 MI); and 21 patients, Class III (7 open and 14 MI). Overall, mean EBL was 397.2 ml and mean hospital LOS was 3.7 days. Minimally invasive TLIF was associated with significantly less EBL and a shorter hospital stay than open TLIF when all patients were evaluated as a single cohort and within individual obesity classes. Overall, the complication rate was 18.1%. Minimally invasive TLIF was associated with a significantly lower total complication rate (11.5% MI vs 28.6% open) and intraoperative complication rate (3.8% MI vs 16.3% open) as compared with open TLIF. When stratified by obesity class, MI TLIF was still associated with lower rates of total and intraoperative complications. This effect was most profound and statistically significant in patients with Class III obesity (42.9% open vs 7.1% MI).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Minimally invasive TLIF offers obese patients perioperative benefits similar to those seen in patients with normal BMI who undergo the same procedure. These benefits include less EBL, a shorter hospital stay, and potentially fewer complications compared with open TLIF. Additional large retrospective studies and randomized prospective studies are needed to verify these findings.</jats:p></jats:sec>

Does Obesity Affect Outcomes After Decompressive Surgery for Lumbar Spinal Stenosis? A Multicenter, Observational, Registry-Based Study

“…The vast majority of these patients had undergone fusion procedures. These findings reinforce results from previous studies in obese patients undergoing spine surgery (18,26,27). Although fusion procedures seem to provide equal functional outcomes in obese patients, there are serious concerns against its use in the absence of radiological instability (i.e., spondylolisthesis) (12,14).…”

Minimally invasive versus open transforaminal lumbar interbody fusion: comparison of clinical outcomes among obese patients

“…While our study contains a relatively small sample size in each stratum, we did not detect a difference in the relationship between surgical approach and clinical outcomes according to obesity class. Furthermore, consistent with the literature suggesting that perioperative complication rates, as well as EBL, may also be lower for the MI approach, 18 our study underscores these findings in the MI cohort in the obese population.…”

Assessment of radiographic and clinical outcomes of an articulating expandable interbody cage in minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis

“…1,3,16,35 Although MIS TLIF is associated with a significant learning curve, increased use of fluoroscopy, and risk of nerve injury, 2,6,[26][27][28][44][45][46][47] its benefits over open TLIF include decreased operating time, decreased intraoperative blood loss, decreased hospital stay, improved cost-effectiveness, faster return to work, and decreased pain. 20,24,29,32,[37][38][39]42 One controversy with MIS TLIF is the ability to provide adequate reduction of spondylolisthesis and correction of radiographic parameters, or even whether such changes are necessary. 7,8,14,30,33,40 With a growing body of evidence emphasizing the finding that the restoration and maintenance of spinopelvic parameters after spine surgery is associated with improved outcomes, 5,12,17,18,25,34,36,41 there has been interest in applying these principles to MIS TLIF as well.…”