Effect of Body Mass Index on Perioperative Outcomes in Minimally Invasive Oblique Lateral Lumbar Interbody Fusion versus Open Fusions: A Multivariant Analysis

Abbasi, Hamid Reza; Grant, Alex

doi:10.7759/cureus.2288

Cited by 13 publications

(15 citation statements)

References 25 publications

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“…Obesity is a significant factor in the initial clinical and radiological findings associated with lumbar spine disease [9]. Although there have been reports regarding the effects of obesity on surgical outcome [10-14], no study on TLIF procedure has compared the peri-operative data of patients with BMI < 30 kg/m 2 to peri-operative data of patients with BMI 30–39 kg/m 2 . TLIF surgery has been performed for many years and is a generally accepted procedure [6].…”

Section: Discussionmentioning

confidence: 99%

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

Gökcen

Öztürk

2018

Cureus

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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/m 2 and BMI 30–39.9 kg/m 2 . Parameters were subjected to statistical analysis according to the BMI. Results There were 26 patients in the BMI < 30 kg/m 2 group and 27 patients in the BMI 30–39.9 kg/m 2 group. The average age of the patients was 60.8 years (30–70 years), and the average BMI was 29.9 kg/m 2 (23.1–39.9 kg/m 2 ). 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.

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Section: Discussionmentioning

confidence: 99%

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

Gökcen

Öztürk

2018

Cureus

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“…Based on the NOS (supplementary file; Table S2 ), the non-randomized controlled trials involved in this study were considered to be of high quality (5–9 points). 36 Two studies 32 , 35 received 8/9, two studies 31 , 34 received 7/9, and the last study 33 received 6/9 (supplementary file; #2). In addition, the GRADE standard quality classification principle showed that low back pain VAS score, ODI index score, and complication rate were medium-quality evidence.…”

Section: Resultsmentioning

confidence: 99%

Comparison of Perioperative and Postoperative Outcomes of Minimally Invasive and Open TLIF in Obese Patients: A Systematic Review and Meta‑Analysis

Chen¹,

Lin²,

Rui³

et al. 2022

JPR

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Purpose Previous studies have demonstrated that minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) is comparable to the open approach in terms of efficacy and safety. However, few comparative studies of surgical procedures in patients with obesity show that they may react differently to open-TLIF (O-TLIF) and MI-LTIF approaches. Patients and Methods The main indicators were complications, visual analog scale (VAS) score, and Oswestry Disability Index (ODI) score, and secondary indicators were operative time, blood loss, and hospital stay. Results No significant differences in the VAS and ODI scores for back pain at the last follow-up and wound infection rates were observed between the two groups. Dural tear incidence and complication rate were significantly lower in the MI-TLIF group than that in the O-TLIF group (P = 0.002 and 0.001, respectively). No significant difference in operative time was found between the two groups. There was less blood loss and shorter hospital stay (P = 0.001 and 0.002, respectively) in the MI-TLIF group than that in the O-TLIF group. Conclusion Compared with O-TLIF, MI-TLIF is an effective and safe surgical option for patients with obesity, which resulted in similar improvements in pain and functional disability, as well as a lower complication rate.

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“…6,7 Abbasi and Grant demonstrated that obesity was associated with increased surgical time and blood loss in transforaminal lumbar interbody fusion but not in OLIF. 16 A review by Goyal et al analyzed 32 studies (23,415 lumbar spine surgery patients), and they found that obese patients undergoing open spine surgery had higher blood loss, longer operative times, and higher reoperation rates than nonobese patients. However, while they did not find a difference in operative times and blood loss between obese and nonobese patients undergoing minimally invasive spine surgery, they did find that obese patients had longer operative times for MIS.…”

Section: Discussionmentioning

confidence: 99%

The effect of obesity on perioperative morbidity in oblique lumbar interbody fusion

Burch

Mummaneni³

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEObese patients have been shown to have longer operative times and more complications from surgery. However, for obese patients undergoing minimally invasive surgery, these differences may not be as significant. In the lateral position, it is thought that obesity is less of an issue because gravity pulls the visceral fat away from the spine; however, this observation is primarily anecdotal and based on expert opinion. The authors performed oblique lumbar interbody fusion (OLIF) and they report on the perioperative morbidity in obese and nonobese patients.METHODSThe authors conducted a retrospective review of patients who underwent OLIF performed by 3 spine surgeons and 1 vascular surgeon at the University of California, San Francisco, from 2013 to 2018. Data collected included demographic variables; approach-related factors such as operative time, blood loss, and expected temporary approach-related sequelae; and overall complications. Patients were categorized according to their body mass index (BMI). Obesity was defined as a BMI ≥ 30 kg/m2, and severe obesity was defined as a BMI ≥ 35 kg/m2.RESULTSThere were 238 patients (95 males and 143 females). There were no significant differences between the obese and nonobese groups in terms of sex, levels fused, or smoking status. For the entire cohort, there was no difference in operative time, blood loss, or complications when comparing obese and nonobese patients. However, a subset analysis of the 77 multilevel OLIFs that included L5–S1 demonstrated that the operative times for the nonobese group was 223.55 ± 57.93 minutes, whereas it was 273.75 ± 90.07 minutes for the obese group (p = 0.004). In this subset, the expected approach-related sequela rate was 13.2% for the nonobese group, whereas it was 33.3% for the obese group (p = 0.039). However, the two groups had similar blood loss (p = 0.476) and complication rates (p = 0.876).CONCLUSIONSObesity and morbid obesity generally do not increase the operative time, blood loss, approach-related sequelae, or complications following OLIF. However, obese patients who undergo multilevel OLIF that includes the L5–S1 level do have longer operative times or a higher rate of expected approach-related sequelae. Obesity should not be considered a contraindication to multilevel OLIF, but patients should be informed of potentially increased morbidity if the L5–S1 level is to be included.

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Effect of Body Mass Index on Perioperative Outcomes in Minimally Invasive Oblique Lateral Lumbar Interbody Fusion versus Open Fusions: A Multivariant Analysis

Cited by 13 publications

References 25 publications

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

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

Comparison of Perioperative and Postoperative Outcomes of Minimally Invasive and Open TLIF in Obese Patients: A Systematic Review and Meta‑Analysis

The effect of obesity on perioperative morbidity in oblique lumbar interbody fusion

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