Introduction: Minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) has proven to be effective in the treatment of degenerative spine disease. Compared to open TLIF, MI TLIF has been associated with less estimated blood loss (EBL), less postoperative pain, and shorter length of stay (LOS). However it is uncertain whether these advantages from MI TLIF also benefit obese patients.
Methods: Obese (BMI > 30) patients that underwent single level TLIF were identified. Patients were categorized according to BMI: class I obesity (BMI of 30-34.9), class II obesity (BMI of 35.0-39.9), and class III obesity (40 or more). Patients were stratified by TLIF approach: open vs. MI. Perioperative outcomes including EBL,complications and LOS were compared.
Results: 127 patients were analyzed: 49 open and 78 MI. 61 patients had class I obesity (23 open and 38 MI), 45 had class II obesity (19 open and 26 MI), and 21 patients had class III obesity (7 open and 14 MI). Overall mean EBL was 397.2 cc, and length of stay was 3.7 days. MI TLIF was associated with significantly less EBL and shorter LOS than open TLIF when all patients were evaluated as a single cohort and within individual obesity class. Overall, complication rate was 18.1%. MI TLIF was associated with a significantly lower total complication rate (11.5% vs. 28.6%) and intraoperative complication rate (3.9% vs. 16.3%) compare to open TLIF. When stratified by obesity class, MI TLIF still was associated with lower rates of total and intraoperative complications. This effect was most profound and statistically significant in patients with class III obesity (open, 42.9% vs. MI, 7.1%).
Conclusions: MI TLIF is able to offer obese patients similar perioperative benefits seen in patients with normal BMI that undergo MI TLIF. These benefits include less EBL, shorter hospital stay, and potentially fewer complications compared to open TLIF.
Patient Care: Suggests that there is a potential benefit of minimally invasive spinal surgery in the obese.
Learning Objectives: 1. Obese patients undergoing MI TLIF had decreased EBL, LOS, complications compared to patients undergoing open TLIF