Impact of Obesity on Complication Rates, Clinical Outcomes, and Quality of Life after Minimally Invasive Transforaminal Lumbar Interbody Fusion

Background Percutaneous pedicle screw fixation in obese patients remains a surgical challenge. We aimed to compare patient-reported outcomes and complication rates between obese and nonobese patients who were treated by minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods The authors retrospectively reviewed patients who underwent MIS-TLIF at a single institution between 2011 and 2014. Patients were classified as obese (body mass index [BMI] >= 30kg/m (2) ) or nonobese (BMI<30kg/m (2) ), according to their BMI. Outcomes assessed were complications, numerical rating scale (NRS) scores for back and leg pain, Oswestry Disability Index (ODI), and 36-Item Short-Form Survey (SF-36) scores. Results The final study group consisted of 71 patients, 24 obese (33.8%, 34.83.8kg/m (2) ) and 47 nonobese (66.2%, 25.4<plus/minus>2.9kg/m (2) ). Instrumentation failures (13.6 vs. 17.0%), dural tears (17.2 vs. 4.0%), and revision rates (16.7 vs. 19.1%) were similar between both groups ( p >0.05). Perioperative improvements in back pain (4.3 vs. 5.4, p =0.07), leg pain (3.8 vs. 4.2, p =0.6), and ODI (13.3 vs. 22.5, p =0.5) were comparable among the groups and persisted at long-term follow-up. Obese patients had worse postoperative physical component SF-36 scores than nonobese patients (36.4 vs. 42.7, p =0.03), while the mental component scores were not statistically different ( p =0.09). Conclusion Obese patients can achieve similar improvement of the pain intensity and functional status even at long-term follow-up. In patients with appropriate surgical indications, obesity should not be considered a contraindication for MIS-TLIF surgery.