Introduction: Low back pain is a major health problem especially if accompanying obesity as aggravating factor. Minimally invasive treatment (TLIF) as a modality to treat different causes of can lead to excellent clinical outcomes.
Methods: Hundred and five patients (68(64.8%) female, 37(35.2%) male, average age 64.7 years old) with BMI =30 kg/m2 with grade I or II spondylolisthesis operated by TLIF were retrospectively re-viewed from November 2011 to April 2017. These patients were categorized into three obesity cat-egories: BMI 30 -34.9kg/m2 (Class I), 35-39.9kg/m2 (Class II), and =40kg/m2 (Class III). Oswestry disability index, Pain analogue scale, operative time, estimated blood loss (EBL), post-operative complications and hospital stay (LOS) and fusion rates were analyzed.
Results: Average follow-up time was 2.6 years. Obesity categories included the following: 53 class 1, 33 class 2, and 19 class 3 having chronic back pain symptoms averaging 6 years range 1 to 60 years. All patients underwent single level TLIF at the L3-4(n=10 ), L4-5(n=72), or L5-S1(n=23 ) level. Mean operative time was 201 minutes ± 45 minutes, EBL was 144 ml ± 55 ml and mean LOS was 4.4 days ± 2.1 days. VAS decreased from 8 pre-op to 3 at 3 months postoperative and 2 at one year, ODI decreased from 43 pre-op to 31 at 3 months post-op and 22 at one year. Complications rate was 4.9%, fusion rate was > 93% at 3 and 12 months follow-up based on dynamic plain radi-ographs. Re-operation rates was 1.1% for adjacent level pathology.
Conclusions: MI-TLIF surgery in obese patients with debilitating back pain from lumbar spondylolisthesis has excellent clinical outcomes.
Patient Care: By getting excellent clinical outcomes for obese patients with good fusion rates.
Learning Objectives: the use of MI-TLIF surgery in obese patients with debilitating back pain from lumbar spondylolisthesis has excellent clinical outcomes.