Does Obesity Make Transforaminal Lumbar Interbody Fusion More Difficult: A Retrospective Analysis

Objective To evaluate and compare peri-operative technical difficulties associated with single-level transforaminal lumbar interbody fusion (TLIF) and peri-operative outcomes between obese and non-obese patients. Subjects and methods The data, including age, blood transfusion volume, preoperative hemoglobin/hematocrit levels, operative time, blood loss, fluoroscopy time, skin incision length, and body mass index (BMI), of 53 patients undergoing single-level TLIF (L4-5 or L5-S1) between 2016 and 2018 were analyzed retrospectively. The patients were divided into two groups: BMI < 30 kg/m² and BMI 30-39.9 kg/m². Parameters were subjected to statistical analysis according to the BMI. Results There were 26 patients in the BMI < 30 kg/m² group and 27 patients in the BMI 30-39.9 kg/m² group. The average age of the patients was 60.8 years (30-70 years), and the average BMI was 29.9 kg/m² (23.1-39.9 kg/m²). The fluoroscopy times and skin incision lengths were significantly different between the two groups (p < 0.05). Conclusions An experienced surgical team can safely apply the TLIF procedure in patients with obesity but it should be taken into consideration by surgeons before surgery. Some modifications in the surgical technique, including, further lateral dissection and wider skin incision in the TLIF technique for obese patients may be required during the procedure. This approach makes TLIF technique easier and safer in obese patients. The longer fluoroscopy times in obese patients indicate that more radiation exposure occurs during TLIF and that necessary precautions should be taken for maintaining surgical team and patient health.