Minimally invasive fusion seen as viable alternative for obese patients with spine disease
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Results showed minimally invasive transforaminal lumbar interbody fusion is an appropriate alternative to traditional anterior and posterior lumbar fusion in obese patients with degenerative spine disease.
Daniel Coban, MD, and colleagues from the department of orthopedic surgery at St. Joseph’s University Medical Center retrospectively analyzed data from two matched cohorts of 74 obese patients (BMI greater than 30 kg/m2) and 74 nonobese patients (BMI less than 30 kg/m2) who underwent minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) at a single institution with a minimum follow-up of 5 years.
According to the study, outcome measures included functional outcome scores, revisions, graft subsidence or fusion, correction of pelvic incidence and lumbar lordosis (PI-LL) mismatch, intraoperative blood loss and operative times.
Coban and colleagues found no significant differences in revision rates, as 17.6% of obese patients and 16.2% of nonobese patients required revision surgery. Researchers also found no differences in correction of PI-LL mismatch or mean change in functional outcome scores between the cohorts. However, researchers noted that obese patients had “clinically minor but statistically significantly” greater intraoperative blood loss and longer operative times compared with nonobese patients. At final follow-up, obese patients had a graft subsidence rate of 8.1% compared with a 5.4% graft subsidence rate in nonobese patients.
Despite slightly greater blood loss, longer operative times and increased intraoperative complexity due to the larger body habitus of obese patients, Coban and colleagues concluded MI-TLIF is still a safe and effective alternative to traditional open lumbar fusion for this patient population.
“Future studies with larger sample sizes and a formal cost analysis should be conducted to further quantify the value of performing MI-TLIF vs. traditional lumbar fusion,” the researchers wrote in the study.
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