Minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis in patients with significant obesity
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Darryl Lau1, John Ziewacz, Paul Park
1Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109-5338, USA.
Abstract:
Comparative studies evaluating efficacy and safety of minimally invasive spinal fusion between patients with significant obesity (body mass index [BMI]≥35 kg/m(2)) and those of normal weight are scarce. We examined complication rates and outcomes for minimally invasive transforaminal lumbar interbody fusion (MITLIF) in patients with significant obesity and those of normal weight undergoing treatment for symptomatic spondylolisthesis. Patients with a BMI≥35 kg/m(2) or <25 kg/m(2) undergoing elective MITLIF for symptomatic spondylolisthesis for the period 2006-09 were identified. Of the 16 patients identified, nine patients with a mean BMI of 37.4 kg/m(2) were included in the obese group, while seven patients with a mean BMI of 23.4 kg/m(2) comprised the normal weight group. Estimated blood loss (EBL), operative time, complication rate, length of hospital stay, and clinical outcomes were assessed. Outcome measures included patient-reported visual analog scale (VAS) score for pain and the Oswestry Disability Index (ODI) questionnaire completed by the patient. No significant differences were found in blood loss (p=0.436), hospital stay (p=0.606), or number of surgical complications (p=0.920) between the two groups. Mean follow-up intervals were 15.0 months for patients with obesity, and 18.6 months for those of normal weight. Both groups had significant improvements in VAS (obese, p=0.003; normal, p=0.016) and ODI (obese, p=0.020; normal, p=0.034) scores. There were no statistically significant differences between normal weight and obese groups in postoperative VAS (p=0.728) and ODI (p=0.886) scores. Patients with significant obesity experienced clinical improvement similar to that of patients with normal weight, suggesting that obesity does not impact MITLIF outcomes. In addition, both groups experienced similar complication rates, operative times, EBL, and length of hospital stay.
Insights
Obese patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF) experienced similar outcomes and complication rates compared to normal-weight individuals. Obesity does not appear to negatively impact MITLIF results for spinal fusion surgery.
Area of Science:
- Spine Surgery
- Minimally Invasive Spine Surgery
- Obesity and Health Outcomes
Background:
- Limited comparative data exists on the efficacy and safety of minimally invasive spinal fusion in significantly obese versus normal-weight patients.
- Significant obesity (body mass index [BMI] ≥35 kg/m²) is a growing concern in surgical patient populations.
- Symptomatic spondylolisthesis often requires surgical intervention, such as minimally invasive transforaminal lumbar interbody fusion (MITLIF).
Purpose of the Study:
- To compare complication rates and clinical outcomes of MITLIF between patients with significant obesity and those of normal weight.
- To evaluate the impact of obesity on the safety and effectiveness of MITLIF for symptomatic spondylolisthesis.
Main Methods:
- A retrospective study identified patients undergoing elective MITLIF for symptomatic spondylolisthesis between 2006-2009.
- Patients were categorized into two groups: significant obesity (BMI ≥35 kg/m²) and normal weight (BMI <25 kg/m²).
- Outcomes assessed included estimated blood loss (EBL), operative time, complication rates, hospital stay, visual analog scale (VAS) for pain, and Oswestry Disability Index (ODI).
Main Results:
- No significant differences were observed in EBL, operative time, complication rates, or length of hospital stay between the obese and normal-weight groups.
- Both groups demonstrated significant improvements in VAS and ODI scores post-surgery.
- Postoperative VAS and ODI scores were not statistically different between the obese and normal-weight groups.
Conclusions:
- Significant obesity does not appear to negatively impact the clinical outcomes or complication rates of MITLIF for symptomatic spondylolisthesis.
- Patients with significant obesity undergoing MITLIF achieve clinical improvements comparable to their normal-weight counterparts.
- MITLIF is a safe and effective surgical option for symptomatic spondylolisthesis, regardless of patient weight status.
