Skip to main content
  • A Prospective, Multi-Institutional Comparative Effectiveness Study of Lumbar Spine Surgery in Morbidly Obese Patients: Does Minimally Invasive TLIF Result in Superior Outcomes.

    Final Number:

    Owoicho Adogwa M.D. M.P.H; Paul Thompson BS; Terence Verla; Ulysses Null; Kemp Knott BS; Kevin T. Huang BA; Joseph S. Cheng MD, MS; Robert E. Isaacs MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Obese and morbidly obese patients undergoing lumbar spinal fusion surgery are a challenge to the operating surgeon. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and Open-TLIF have been performed for many years with good results; however, functional outcomes after lumbar spine surgery in this subgroup of patients remain poorly understood. Furthermore, whether MIS-TLIF or open-TLIF for treatment of degenerative disc disease(DDD) or spondylolisthesis (DS) in morbidly obese results in superior post-operative functional outcomes remains unknown.

    Methods: A nationwide, multi-institutional, prospective spine outcomes registry was utilized for this study. The study group included 148 patients undergoing TLIF for degenerative disc disease or spondylolisthesis; 40 patients underwent MIS-TLIF and 108 patients underwent open-TLIF. Patients completed the Oswestry Disability Index (ODI), MOS Short Form 36 (SF-36), and back and leg pain numerical rating scores before surgery, then at 3, 6, 12, and 24 months after surgery. Clinical outcomes and complication rates were compared between both patient cohorts.

    Results: Compared to preoperative status, VAS back and leg pain, ODI and SF-36 PCS/MCS were improved in both groups. Both MIS-TLIF and open-TLIF patients showed similar 2-year improvement in VAS for back pain(MIS-TLIF: 2.42 ± 3.81 vs. open-TLIF: 2.33 ± 3.67, p=0.89), VAS for leg pain(MIS-TLIF: 3.77 ± 4.53 vs. open-TLIF: 2.67 ± 4.10 ,p=0.18), Oswestry disability index (MIS-TLIF: 11.61 ± 25.52 vs. open-TLIF: 14.88 ± 22.07 ,p=0.47), and SF-36 PCS MIS-TLIF: 8.61 ± 17.72 vs. open-TLIF: 7.61 ± 15.55, p=0.93), and SF-36 MCS MIS-TLIF: 4.35 ± 22.71 vs. open-TLIF: 5.96 ± 21.09, p=0.69). Post-operative complications rates between both cohorts were also not significantly divergent.

    Conclusions: MIS-TLIF is a safe and viable option for lumbar fusion in morbidly obese patients, and when compared to open-TLIF, resulted in similar improvement in pain and functional disability. Post-operative complications rates were also similar.

    Patient Care: This research allows a surgeon to make an informed decision about which operative technique to use in a patient population.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) compare and contrast outcomes in obese patients after MIS-TLIF and open-TLIF.


We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy