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  • What is the Impact of Obesity in MIS vs. OPEN Surgery for Adult Spinal Deformity?

    Final Number:

    Paul Park MD; Praveen V. Mummaneni MD; Frank La Marca MD; Kai-Ming G. Fu MD, PhD; Stacie Nguyen BS MPH; Michael Y. Wang MD, FACS; Juan S. Uribe MD; Neel Anand MD; Gregory Mundis MD; Vedat Deviren MD; Adam S. Kanter MD; Richard G. Fessler MD; Christopher I. Shaffrey MD, FACS; Behrooz A. Akbarnia MD; Peter G Passias MD; Pierce D. Nunley MD; Dean Chou M.D.; Robert Eastlack MD; David O. Okonkwo MD, PhD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Obesity is a significant comorbidity that can increase the risk and technical difficulty of surgery. Previous studies comparing minimally invasive (MIS) to traditional open spinal surgery in the obese have shown similar clinical outcomes but improved perioperative benefits of decreased EBL, LOS, and complications with MIS approaches. Similar studies have not been performed for obese patients undergoing surgery for adult spinal deformity (ASD). This study’s objective was to compare the impact of obesity in the treatment of ASD with MIS compared to open approaches.

    Methods: Two multicenter databases, one involving MIS surgeries and the other open surgeries, were queried. Inclusion criteria for both databases were diagnosis of ASD, minimum 2 year follow-up, and at least one of the following parameters: coronal cobb (CC) =20°, SVA >5cm, PT>25°, thoracic kyphosis >60°. Patients with BMI =30 were identified and then propensity matched for levels fused. 38 patients with 19 in each group were analyzed.

    Results: Patients were well matched with mean ages of 65.4 and 64.3 years and BMI 34.7 and 34.0, respectively for the MIS and open groups. Table 1 lists outcomes between the groups. Mean levels fused were 4.2 for MIS and 2.7 for open. Statistically significant improvement in ODI and VAS were noted within each group. Notably there was no significant difference in radiographic parameters or ODI and VAS scores between groups. A significant decrease in EBL was noted in the MIS group; however, complications and re-operation frequency were not statistically different.

    Conclusions: Similar clinical and radiographic improvements were noted for MIS and open treatment of ASD. Although EBL was less in the MIS group, the frequency of complications and reoperations were similar suggesting the potential benefit of MIS approaches may be mitigated by obesity. Larger comparative studies are needed to clarify the benefit of MIS in the obese undergoing ASD surgery.

    Patient Care: This study evaluates how well minimally invasive approaches can benefit obese patients with deformity.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the impact of obesity on outcomes, 2) Discuss the impact of MIS procedures on perioperative and long-term outcomes for obese patients undergoing deformity surgery


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