Related Experiment Video
Updated: Sep 14, 2025
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Three-dimensional Navigation-guided, Prone, Single-position, Lateral Lumbar Interbody Fusion Technique
Published on: July 15, 2021
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Patient-Reported Outcomes After Lumbar Fusion Using Transforaminal vs. Lateral Lumbar Interbody Fusion Across BMI
Rafael A Garcia1, Kari Odland1, Jonathan Sembrano1
1Orthopedic Surgery, University of Minnesota, Minneapolis, USA.
Cureus
|July 24, 2025
Summary
Lumbar fusion effectively reduces disability for patients with spondylolisthesis, regardless of BMI. Both transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) show similar outcomes, suggesting BMI should not solely guide surgical approach selection.
Area of Science:
- Spine surgery
- Orthopedics
- Neurosurgery
Background:
- Lumbar spondylolisthesis frequently causes pain and disability, necessitating surgical intervention.
- While BMI's impact on lumbar fusion outcomes is studied, the comparative effectiveness of TLIF and LLIF across BMI categories is unclear.
- This study investigates patient-reported outcomes (PROs) for TLIF and LLIF in low-grade spondylolisthesis, stratified by BMI.
Purpose of the Study:
- To compare patient-reported outcomes (PROs) following transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) in patients with low-grade lumbar spondylolisthesis.
- To evaluate the influence of body mass index (BMI) stratification on the effectiveness of these surgical approaches.
- To determine if BMI affects the achievement of minimal clinically important difference (MCID) for disability and pain.
Main Methods:
- Retrospective analysis of 72 patients with low-grade degenerative or isthmic spondylolisthesis undergoing lumbar fusion (2010-2023).
- Patients stratified into four BMI groups: non-obese (<30), class I (30-34.9), class II (35-39.9), and class III (≥40).
- Assessment of Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for pain at baseline and 12 months, comparing MCID achievement between TLIF and LLIF.
Main Results:
- Significant improvements in ODI and VAS scores observed across all BMI categories at 12 months (p<0.001).
- TLIF and LLIF demonstrated comparable rates of achieving MCID, with no statistically significant difference between approaches (p=0.72).
- Sustained improvements in functional outcomes were noted in non-obese and class II BMI categories.
Conclusions:
- Lumbar fusion, utilizing both TLIF and LLIF, effectively reduces disability in patients with spondylolisthesis across all BMI categories.
- Obesity does not represent a contraindication for lumbar fusion, and surgical approach selection should prioritize individual patient factors over BMI.
- Further prospective studies with longer follow-up are warranted to fully elucidate the long-term outcomes of these surgical techniques.
