gms | German Medical Science

Objective: Percutaneous pedicle screw placement can be challenging in obese patients. The objective of this study was to compare complication rates, patient-reported outcomes and quality of life between obese and non-obese patients that underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative spine disease.

Methods: This is a review of consecutive patients that were treated by MIS-TLIF at a single center between 2011 and 2014. According to their body mass index (BMI), patients were classified as obese (BMI ≥30 kg/m2) or non-obese (BMI <30 kg/m2). Primary outcome measures were surgical complications, numerical rating scale (NRS) scores for back and leg pain, Oswestry Disability Index (ODI) and quality of life as determined by the Short-form 36 (SF36) scores.

Results: A total of 71 patients were included, of which 24 were obese (34%, 35 ± 4 kg/m2) and 47 were non-obese (66%, 25 ± 3 kg/m2). Regarding complication rates, no significant differences were observed among instrumentation failures (14% vs. 17%, p=0.07), dural tears (17% vs. 4%) and revision rates (17% vs. 19%). There were no significant differences in postoperative improvements in back pain (4.3 vs. 5.4 points, p=0.07), leg pain (3.8 vs. 4.2 points, p=0.6) and ODI (13.3 vs. 22.5 points, p=0.5), both postoperatively and at long-term follow-up. Obese patients had worse postoperative physical component SF36 scores than non-obese patients (36.4 vs. 42.7 points, p=0.03), while the mental component scores were statistically indifferent (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 therefore not be considered a contraindication for MIS-TLIF surgery.