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Complications with Minimally Invasive Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis in the Obese Population

Buyuk, Abdul Fettah MD; Shafa, Eiman MD; Dawson, John M. PhD; Schwender, James D. MD

doi: 10.1097/BRS.0000000000003160

Study Design. A level-3 retrospective cohort analysis.

Objective. The aim of this study was to describe obesity's effect on complications and outcomes in degenerative spondylolisthesis patients treated by minimally invasive transforaminal lumbar interbody fusion (MI TLIF).

Summary of Background Data. Obesity is associated with a greater complication rate among lumbar spine surgery patients. Poor clinical outcomes might likewise be supposed, but the association is not well established. Minimally invasive techniques have been developed to reduce complications and improve clinical outcomes in comparison to traditional open techniques.

Methods. We reviewed 134 consecutive patients with degenerative spondylolisthesis undergoing MI TLIF. Subjects were grouped into nonobese (N = 65) and obese (N = 69) cohorts. The obese group was further subdivided by BMI. Patient demographics, perioperative complications, and outcome scores were collected over a minimum of 24 months. Four periods (intraoperative, postoperative hospitalization, 6-month, and 24-month postoperative) were assessed.

Results. Cohort demographics were not significantly different, but it was noted that obese patients had more major comorbidities than nonobese patients. There was no difference in intraoperative complications between the two groups. The in-hospital complication rate was significantly greater in the obese group. The 6-month postoperative complication rate was not different between cohorts. Wound drainage was most common and noted only in the obese cohort. Complications at 24 months were not different but did trend toward significance in the obese for recurrence of symptoms and total complications. Functional outcome was better among nonobese subjects compared with obese subjects at every interval (significant at 6 and 12 months). Back pain scores were significantly better among nonobese subjects than obese subjects at 24 months, but Leg Pain scores were not different.

Conclusions. MI TLIF can be safely performed in the obese population despite a higher in-hospital complication rate. Knowledge of common complications will help the treatment team appropriately manage obese patients with degenerative spondylolisthesis.

Level of Evidence: 3

Complications and outcomes in obese and nonobese patients with degenerative spondylolisthesis treated by minimally invasive transforaminal lumbar interbody fusion were studied. A higher in-hospital complication rate was noted for obese subjects. Functional outcome and leg pain 2 years postoperatively was unrelated to obesity, and back pain was less for nonobese subjects.

Twin Cities Spine Center, Minneapolis, MN.

Address correspondence and reprint requests to Abdul Fettah Buyuk, MD, Twin Cities Spine Center, 913 East 26th Street, Minneapolis, MN 55404; E-mail:

Received 15 April, 2019

Revised 20 May, 2019

Accepted 5 June, 2019

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.