Does a high BMI affect the outcome of minimally invasive TLIF? A retrospective study of 207 patients

Sharma, Ayush; Shakya, Akash; Singh, Vijay; Mangale, Nilesh; Kakadiya, Ghanshyam; Jaiswal, Ajay; Marathe, Nandan

doi:10.1007/s00586-021-06907-z

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…Although the primary goal of this study was to evaluate the clinical outcomes of patients undergoing different lumbar fusion techniques, our finding that higher BMI was associated with worse preoperative and postoperative patient-reported outcomes is consistent with previous studies [18]. Other authors, however, have shown no clear relationship between BMI and pain outcomes following lumbar surgery, particularly in patients undergoing MI-TLIF [19,20]. Our demonstration that advancing age was not a predictor of poorer postoperative outcomes, with younger patients having worse preoperative and postoperative scores, is consistent with the literature showing equivalent, if not improved, outcomes from lumbar fusion in patients over 65 years [21].…”

Section: Discussionsupporting

confidence: 87%

Comparative Outcome Data Using Different Techniques for Posterior Lumbar Fusion: A Large Single-Center Study

Lewis,

Marya,

Carrasco

et al. 2023

Asian Spine J

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Study Design: Retrospective single-center study.Purpose: This study aims to evaluate perioperative and intermediate-term clinical outcomes of patients undergoing different lumbar fusion techniques.Overview of Literature: Various open and minimally invasive techniques for lumbar fusion are available, but previous studies comparing lumbar fusion techniques have heterogeneous data, making interpretation challenging.Methods: Between 2011 and 2018, data from 447 consecutive patients undergoing one/two-level lumbar fusion were analyzed. Posterior lumbar interbody fusion (PLIF) with bilateral muscle strip or Wiltse approach, open transforaminal lumbar interbody fusion (TLIF) and minimally invasive TLIF, and posterolateral fusion only were among the surgical techniques used. Core outcomes measure index (COMI) questionnaires were distributed before surgery and at 3 months, 1 year, and 2 years postoperatively to establish patient selfreported outcome measures. Demographic data (age, gender, and body mass index [BMI]) for each patient were also collected in addition to surgical indication, previous operative history, perioperative outcomes, and complications, and whether later revision surgery was required. Pearson’s chi-square test, Kruskal-Wallis test, repeated measure mixed-effects models, and ordinal logistic regression were used for statistical analysis.Results: Postoperative COMI scores improved across all procedures compared with pre-surgery (p<0.001). There was no significant difference between different postoperative COMI scores. Significant predictors of higher postoperative COMI score included higher pretreatment COMI score (p≤0.001), previous surgery (p≤0.04), younger age (p≤0.05), higher BMI (p≤0.005), and the indications of lytic spondylolisthesis (p=0.02) and degenerative disc disease (p<0.001). Patients undergoing minimally invasive TLIF had a significantly shorter post-surgery stay than patients undergoing open PLIF (Kruskal-Wallis test, p=0.03).Conclusions: At 2 years postoperatively, there was no significant difference in clinical outcomes between open and minimally invasive techniques. These findings suggest that the main determinant of surgical approach should be surgeon preference and training.

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Section: Discussionsupporting

confidence: 87%

Comparative Outcome Data Using Different Techniques for Posterior Lumbar Fusion: A Large Single-Center Study

Lewis,

Marya,

Carrasco

et al. 2023

Asian Spine J

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“…27,28 Minimally invasive spine was developed as a potential solution to the above-mentioned problems by reducing the amount of iatrogenic soft-tissue injury while still accomplishing the traditional goals of the open procedure. 29,30 We found that the mean reduction in LMM in the MIS-TLIF group was significantly less than that in the CO-TLIF group. This correlates with some of the findings in previously published literature (Table 1) where authors have compared the MFM damage between CO-TLIF and MIS-TLIF utilizing various modalities.…”

Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Does Conventional Open TLIF cause more Muscle Injury when Compared to Minimally Invasive TLIF?—A Prospective Single Center Analysis

Dave

Marathe

Mayi

et al. 2022

Global Spine Journal

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Study design Prospective, observational. Objectives The aim of our study was to assess the amount of reduction in lean muscle mass (LMM) of multifidus muscle (MFM) between conventional open Transforaminal lumbar interbody fusion (CO-TLIF) as compared to Minimally invasive spine Transforaminal lumbar interbody fusion (MIS-TLIF). Methods This study was conducted between 2017 and 2020. It included 100 patients divided into two groups, 50 patients treated with CO-TLIF, 50 treated with MIS-TLIF. Only patients undergoing single level, primary lumbar fusion at L4-5 or L5-S1 level for degenerative pathologies were included. All patients were assessed by magnetic resonance imaging (MRI) scans 1-year post surgery. Measurements were performed using ImageJ image processing program. Results Mean percentage reduction in LMM in CO-TLIF group was 45.52 ± 12.36% and MIS-TLIF group was 25.83 ± 9.64% [statistically significant (t = 8.78, P < .001)]. Mean percentage reduction in LMM on side of cage insertion was 39.63 ± 15.96% and opposite side was 31.40 ± 15.01% [statistically significant (t = 9.06, P < .001)]. Mean reduction of LMM among males was 29.38 ± 15.23% and females was 40.42 ± 12.67% [statistically significant (t = −3.95, P < .001)]. We observed significant but weak degree of correlation between age and percentage reduction of LMM (r = .22, P = .028). Conclusion Mean reduction in LMM was greater in CO-TLIF group as compared to MIS-TLIF. There was greater reduction in LMM in females and on side of cage insertion. We also found greater reduction in LMM with increasing age in both groups.

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“…Some existing studies have suggested that BMI does not significantly influence functional and clinical outcomes after TLIF surgery. 30 , 31 Nonetheless, other studies have shown that patients with higher BMI undergoing spine surgery tend to have significantly greater leg pain and disability and poorer patient-reported outcomes and satisfaction than their counterparts with lower BMI. 32 , 33 It is likely that patients with lower BMI and better functional status at baseline can better engage in postoperative rehabilitation, so as to achieve clinically significant improvement in function and quality of life.…”

Section: Discussionmentioning

confidence: 99%

What Preoperative Factors Are Associated With Achieving a Clinically Meaningful Improvement and Satisfaction After Single-Level Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis?

Moorthy

Goh

Soh

2022

Global Spine Journal

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Study design Prospective cohort study. Objectives The purpose of this study was to identify preoperative factors associated with clinically meaningful improvement, patient satisfaction and expectation fulfilment at 2 years follow-up in patients undergoing single-level TLIF for degenerative spondylolisthesis. Methods Patients who underwent a primary, single-level TLIF for degenerative spondylolisthesis between 2006 and 2015 were identified from a prospectively maintained institutional spine registry. Baseline characteristics and PROMs including the Oswestry Disability Index (ODI), 36-Item Short-Form Physical Component Score (SF-36 PCS), Mental Component Score (SF-36 MCS), Visual Analogue Scale (VAS) back pain, and VAS leg pain were collected preoperatively, at 1 month, 3 months, 6 months, and 2 years. Results A total of 997 patients were included. Multivariate analyses showed that increasing age (OR 1.039, P < .001) and better preoperative ODI (OR .984, P = .018) were associated with achieving minimal clinically important difference (MCID) for VAS Back. Increasing age (OR 1.032, P = .007) and better preoperative VAS Back (OR .783, P < .001) were associated with achieving MCID for VAS Leg. Lower BMI (OR .952, P = .024) and better preoperative ODI (OR .976, P < .001) were associated with achieving MCID for SF-36 PCS. Importantly, a better preoperative SF-36 MCS was associated with MCID attainment for ODI (OR 1.038, P < .001), satisfaction (OR 1.034, P < .001) and expectation fulfilment (OR 1.024, P < .001). Conclusion Patients who were older, have less preoperative disability and better preoperative mental health were significantly more likely to attain clinically meaningful improvement in PROMs and postoperative satisfaction after single-level TLIF. Identification of these factors would aid surgeons in patient selection and surgical counselling for single-level TLIF.

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Does a high BMI affect the outcome of minimally invasive TLIF? A retrospective study of 207 patients

Cited by 4 publications

References 25 publications

Comparative Outcome Data Using Different Techniques for Posterior Lumbar Fusion: A Large Single-Center Study

Comparative Outcome Data Using Different Techniques for Posterior Lumbar Fusion: A Large Single-Center Study

Does Conventional Open TLIF cause more Muscle Injury when Compared to Minimally Invasive TLIF?—A Prospective Single Center Analysis

What Preoperative Factors Are Associated With Achieving a Clinically Meaningful Improvement and Satisfaction After Single-Level Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis?

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