Single-Level Anterior Lumbar Interbody Fusion versus Minimally Invasive Transforaminal Lumbar Interbody Fusion at L5/S1 for an Obese Population

Abstract

To compare perioperative outcomes, patient-reported outcome measures (PROMs), and minimal clinically important difference (MCID) achievement rates for an obese patient cohort between single-level minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) vs. anterior lumbar interbody fusion (ALIF). Overview of Literature: To the best of our knowledge, no study has compared the outcomes of MIS TLIF and ALIF in an obese population. Methods: Obese patients (body mass index [BMI] ≥30.0 kg/m 2 ) who underwent single-level MIS TLIF or ALIF at L5/S1 were included in the study. Demographic/perioperative variables, presenting patient pathology, and 1-year arthrodesis statistics were collected. PROM scores for Visual Analog Scale (VAS) back/leg, Oswestry Disability Index, 12-item Short Form Physical Composite Scale, and Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF) were collected from preoperative and postoperative (6 weeks, 12 weeks, 6 months, 1 year, 2 years) PROMIS-PF. The obese patients were classified based on the procedure they underwent (MIS TLIF vs. ALIF). Results:The criteria were met by 210 patients in total. After coarsened exact matching for Charlson comorbidity index score, degenerative spondylolisthesis, isthmic spondylolisthesis, degenerative scoliosis, foraminal stenosis, insurance, male, and ethnicity, 94 obese patients were included in the total cohort, with 59 receiving MIS TLIF and 35 receiving ALIF. ALIF recipients had higher PROMIS-PF scores at 6 weeks (p=0.014) and 12 weeks (p=0.030), as well as a higher VAS leg at 2 years (p=0.017). Following multiple regression accounting for differences in baseline BMI, only the 6-week PROMIS-PF significantly differed (p=0.028), with no other intergroup differences in mean PROMs between fusion types. Aside from a significantly higher 6-week MCID achievement rate for PROMIS-PF among ALIF recipients (p=0.006), no differences in attainment were observed. Conclusions: There were no statistically significant differences in perioperative characteristics, fusion rates, PROMs, or MCID achievement between obese patients receiving MIS TLIF vs. ALIF. As a result, our findings indicate that MIS TLIF and ALIF at L5/S1 are equally effective in an obese patient population.

The Impact of Posterior Intervertebral Osteophytes on Patient-Reported Outcome Measures After L5-S1 Anterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion

“…Our study also found that the ODI MCID threshold was achieved in 60% and 52% of patients who underwent TLIF and ALIF, respectively, at 6-month postoperative follow-up (P = 0.585). However, the same study by Patel et al 26 same ODI MCID threshold of 14.9 found that patients who underwent ALIF had a lower rate of achieving ODI MCID at 6 months (37.5%) compared with TLIF (68.6%). However, their cohort had an average BMI of 34.1 compared with our average of 26.6.…”

Cumulative Burden of Being Underweight Increases the Risk of Hip Fracture: A Nationwide Population-Based Cohort Study

“…At each K-NHE examination, weight and height were measured and the BMI was calculated as weight/(height)^2. At the index health examination, we classified all subjects by BMI status: <18.5 (underweight), <23 (healthy), <25 (near overweight), <30 (overweight), and ≥30 (obese) using the recognized Asian criteria [ 14 , 15 , 16 ]. The total study population was divided into groups for whom underweight was diagnosed at 0 to 3 examinations.…”

Lumbar Interbody Fusion and Osteobiologics for Lumbar Fusion

“…Since Foley et al [ 31 , 32 ] introduced TLIF using minimally invasive surgery (MIS) to reduce approach-related complications, the MIS technique has gained popularity as it has led to better outcomes due to reduced blood loss and muscle damage, shorter operation time, and earlier recovery after surgery compared to the conventional open technique ( Fig. 2 ) [ 25 , 33 - 39 ]. Patient selection for TLIF is similar to that for PLIF.…”