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

Lukas Goertz; Pantelis Stavrinou; Christina Hamisch; Moritz Perrech; Dierk-Marko Czybulka; Kaveh Mehdiani; Marco Timmer; Roland Goldbrunner; Boris Krischek

doi:10.1055/s-0040-1718758

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2021; 82(02): 147-153
DOI: 10.1055/s-0040-1718758

Original Article

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

Lukas Goertz

¹Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany

,

Pantelis Stavrinou

¹Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany

,

Christina Hamisch

¹Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany

,

Moritz Perrech

¹Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany

,

Dierk-Marko Czybulka

¹Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany

,

Kaveh Mehdiani

¹Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany

,

Marco Timmer

¹Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany

,

Roland Goldbrunner

¹Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany

,

Boris Krischek

¹Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany

› Author Affiliations

Abstract

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.

Keywords

percutaneous interbody fusion - minimally invasive transforaminal lumbar interbody fusion - MIS-TLIF - obesity - SF-36

Full Text

References

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