Impact of morbid obesity (BMI &gt; 40 kg/m2) on complication rate and outcome following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF)

Krüger, Marie T.; Naseri, Yashar; Hohenhaus, Marc; Hubbe, Ulrich; Scholz, Christoph; Klingler, Jan-Helge

doi:10.1016/j.clineuro.2019.02.004

Cited by 20 publications

(30 citation statements)

References 15 publications

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“…29 Further studies yielded similar results regarding complication rates, hence corroborating a high safety profile of MIS-TLIF for obese patients. 30 Among obese patients, the mean postoperative NRS improvement was 4.3 points for back pain and 3.8 points for leg pain, which remained significant at long-term follow-up. Previous studies on MIS-TLIF for obese patients yielded similar results: Lau et al reported a perioperative NRS improvement of 4.1 points, 31 Terman et al reported an improvement of 2.4 points after at least 6 months, 32 and Adogwa et al reported a 2-year improvement of 2.4 points for back pain and of 3.8 points for leg pain.…”

Section: Discussionmentioning

confidence: 83%

Impact of Obesity on Complication Rates, Clinical Outcomes, and Quality of Life after Minimally Invasive Transforaminal Lumbar Interbody Fusion

Goertz

Stavrinou

Hamisch

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Background Percutaneous pedicle screw fixation in obese patients remains a surgical challenge. We aimed to compare patient-reported outcomes and complication rates between obese and nonobese patients who were treated by minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods The authors retrospectively reviewed patients who underwent MIS-TLIF at a single institution between 2011 and 2014. Patients were classified as obese (body mass index [BMI] ≥30 kg/m2) or nonobese (BMI < 30 kg/m2), according to their BMI. Outcomes assessed were complications, numerical rating scale (NRS) scores for back and leg pain, Oswestry Disability Index (ODI), and 36-Item Short-Form Survey (SF-36) scores. Results The final study group consisted of 71 patients, 24 obese (33.8%, 34.8 ± 3.8 kg/m2) and 47 nonobese (66.2%, 25.4 ± 2.9 kg/m2). Instrumentation failures (13.6 vs. 17.0%), dural tears (17.2 vs. 4.0%), and revision rates (16.7 vs. 19.1%) were similar between both groups (p > 0.05). Perioperative improvements in back pain (4.3 vs. 5.4, p = 0.07), leg pain (3.8 vs. 4.2, p = 0.6), and ODI (13.3 vs. 22.5, p = 0.5) were comparable among the groups and persisted at long-term follow-up. Obese patients had worse postoperative physical component SF-36 scores than nonobese patients (36.4 vs. 42.7, p = 0.03), while the mental component scores were not statistically different (p = 0.09). Conclusion Obese patients can achieve similar improvement of the pain intensity and functional status even at long-term follow-up. In patients with appropriate surgical indications, obesity should not be considered a contraindication for MIS-TLIF surgery.

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Section: Discussionmentioning

confidence: 83%

Impact of Obesity on Complication Rates, Clinical Outcomes, and Quality of Life after Minimally Invasive Transforaminal Lumbar Interbody Fusion

Goertz

Stavrinou

Hamisch

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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“…Especially in the case of TLIF after revision surgery, dural tear rate is higher in the literature 18. 360 degree fusion is aimed in TLIF surgery, but pseudarthrosis can be seen 19. Major complications such as vascular injury, ALL rupture, bowel injury, neurological injury, pulmonary embolism, deep vein thrombosis can be seen 13,19…”

Section: Complications Of Tlif Surgerymentioning

confidence: 99%

<p>Transforaminal Lumbar Interbody Fusion For Lumbar Degenerative Disease: Patient Selection And Perspectives</p>

Uçar

Özcan

Polat

et al. 2019

ORR

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Most adults will experience low back pain during their lifetime, with most of these instances resolving or improving without sequelae in a few weeks. For the small number of patients with severe, recalcitrant pain, lumbar fusion may be required, particularly when concomitant leg pain or deformity is present. Lumbar interbody fusion surgery is the usual treatment for degenerative lumbar disease, but it requires a long recovery period. Many surgical techniques have been described in the literature for spondylolisthesis. The main objective is to create interbody fusion, decompression of normal structures and a stable vertebrae. TLIF surgical techniques has a long learning curve. Comorbidities of the patient may make surgery more difficult. Methods such as transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion, anterior lumbar interbody fusion and lateral lumbar interbody fusion are also available for interbody fusion in the literatüre. The aim of this review is to show which patients are more suitable for TLIF surgery and to discuss the advantages and disadvantages of TLIF surgery over other techniques.

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“…length of hospital stay (LOS). Five studies reported the LOS [18,20,26,28,29]. The pooled results using random-effects model indicated that obese patients have similar length of hospital stay with nonobese patients after surgery (MD, 0.37; 95% CI -0.16 to 0.90; n = 709; p = 0.18; I 2 =72%; Figure 3c).…”

Section: Secondary Outcomesmentioning

confidence: 96%

“…Subsequently, after downloading and identifying the full text, 9 articles without access to the inclusion criteria were excluded. Ultimately, this metaanalysis contained a total of 9 eligible studies [17][18][19][20][25][26][27][28][29] published between 1999 and 2018. The speci c process of literature identi cation and selection is shown in Figure 1.…”

Section: Search and Study Selectionmentioning

confidence: 99%

“…The speci c statistics were shown in Figure 4(MD, -0.08; 95% CI -0.75 to 0.59; n = 362; p=0.81 I 2 =0%; Figure 4b) and (MD, 0.29; 95% CI -0.65 to 1.23; n = 247; p =0.55 I 2 =0%; Figure 4c), respectively. Additionally, 3 studies [18,28,29] reported the outcome of late BP-VAS scores (≥24 months after MIS-TLIF). The random-effects forest plot shows no statistical difference was observed in late BP-VAS (MD, 1.43; 95% CI -0.73 to 3.60; n = 249; p=0.19 I 2 =74%; Figure 5b).…”

Section: Secondary Outcomesmentioning

confidence: 99%

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Comparing Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion in Obese and Nonobese Patients: A Systematic Review and Meta-Analysis

Huang¹,

Qin²,

Yang³

et al. 2020

Preprint

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Background: Our study aimed to compare the outcomes of obese and nonobese patients following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).Methods: Relevant studies comparing the outcome of MIS-TLIF between obese and nonobese patients were involved to make a systematic literature review and meta-analysis. All of the comparative studies published in PubMed, MEDLINE, and Web of Science databases as recently as 10 July 2020, were included. Primary outcomes (complications) and secondary outcomes (Oswestry Disability Index (ODI) score, visual analog scale (VAS) score, the length of hospital stay, the duration of surgery, and the estimated blood loss) were assessed between obese patients and nonobese patients. Statistical analysis was performed by Review Manager 5.3 and forest plots were made for each outcome.Results: Nine studies were enrolled in this meta-analysis. BMI correlated significantly with complications, and postoperative complications occurred more frequently in obese patients. Additionally, obese patients after MIS-TLIF were associated with similar Oswestry Disability Index (ODI) score, Visual Analog Scale score for back pain(BP-VAS), and Visual Analog Scale score for leg pain(LP-VAS) scores in early (≤6 months after MIS-TLIF) and late period (≥24 months after MIS-TLIF). There was no significant difference in intraoperative complications, duration of surgery, length of hospital stay, and estimated blood loss between the two groups.Conclusion: Obese patients should not be excluded from MIS-TLIF procedures due to worry about higher postoperative complication rates. Understanding common postoperative complications after MIS-TLIF will improve the treatment of obese patients with the degenerative lumbar disease.

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Impact of morbid obesity (BMI > 40 kg/m2) on complication rate and outcome following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF)

Cited by 20 publications

References 15 publications

Impact of Obesity on Complication Rates, Clinical Outcomes, and Quality of Life after Minimally Invasive Transforaminal Lumbar Interbody Fusion

Impact of Obesity on Complication Rates, Clinical Outcomes, and Quality of Life after Minimally Invasive Transforaminal Lumbar Interbody Fusion

<p>Transforaminal Lumbar Interbody Fusion For Lumbar Degenerative Disease: Patient Selection And Perspectives</p>

Comparing Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion in Obese and Nonobese Patients: A Systematic Review and Meta-Analysis

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