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66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Impact of morbid obesity (BMI >40 kg/m2) on complication rate and short-term outcome following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF)

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  • Marie T. Krüger - Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Freiburg
  • Ulrich Hubbe - Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Freiburg
  • Ronen Sircar - Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Freiburg
  • Christoph Scholz - Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Freiburg
  • Jan-Helge Klingler - Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Freiburg

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocMI.13.07

doi: 10.3205/15dgnc338, urn:nbn:de:0183-15dgnc3387

Published: June 2, 2015

© 2015 Krüger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Obesity is an important public concern issue due to the negative effects on quality of life and health. Studies have shown an association between obesity and higher rates of complications and unfavorable outcomes following open spine surgery. With this study, we intended to identify perioperative complication rates and outcomes in morbidly obese patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) and compare them to normal-weight patients.

Method: We retrospectively reviewed medical records for all adult patients with a body mass index (BMI) >40 kg/m2, undergoing 1- to 2-level MIS TLIF for degenerative disease between February 2009 and February 2014 at a single institution and compared them to age-matched normal weight patients (BMI 20 - 25 kg/m2). We recorded duration of operation, length of hospital stay, use of analgesics (WHO level), and minor and major complications (infections and re-operations) within 30 days of surgery.

Results: We identified 14 patients with a BMI >40 kg/m2 (average BMI = 43.2kg/m2) who underwent MIS TLIF. When compared to 14 normal-weight patients (average BMI = 23.5 kg/m2), morbidly obese patients had significantly longer duration of operation for one level (235 vs. 168 min; P = 0.0264), longer average length of stay (7.7 vs. 5.4; P = 0.0308), and a numerically higher need for analgesics (WHO level; P = 0.0828). However, there was no higher infection or postoperative complication rate with one re-operation in each group due to epidural bleeding. In short-term follow-up, both groups had similar rates of complications such as sacroiliac joint syndrome or persistent lumbar back pain (P = 1.0).

Conclusions: MIS TLIF is technically feasible in morbidly obese patients even if the minimally invasive instruments almost reached their limits in some of these cases due to the depth of the surgical field. We did not identify a higher risk of relevant complications compared to normal-weight patients. Though, the morbid obesity can be considered as the patients’ main disease and will carry other health risks in the further course. Therefore, morbidly obese patients have to attend special programs postoperatively to reduce weight and gain muscular strength to prevent further spinal disorders.