Obesity and Clinical, Radiographic, and Surgical Outcomes After Minimally Invasive Single-Level Transforaminal versus Lateral Lumbar Interbody Fusion

Nafis B. Eghrari, Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, Ohio, USA; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Jonathan J. Lee, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Juan P. Giraldo, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Winward Choy, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Gabriella P. Williams, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Luke K. O'Neill, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
James J. Zhou, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
S Harrison Farber, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Joseph M. Abbatematteo, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Hovhannes M. Saribekyan, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Jay D. Turner, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Laura A. Snyder, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Luis M. Tumialán, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Juan S. Uribe, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@barrowneuro.org.

Document Type

Article

Abstract

OBJECTIVE: To determine the effect of obesity on clinical, radiographic, and surgical outcomes after lateral lumbar interbody fusion (LLIF) versus minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF) and compare the effectiveness of LLIF versus MIS TLIF in treating obese patients. METHODS: A retrospective comparative analysis of patients who underwent single-level L4-5 LLIF or MIS TLIF over a 7-year period was performed. Spinopelvic parameters were compared based on preoperative and postoperative radiographs. Body mass index (BMI) ≥30 was deemed "high"; BMI <30 was deemed "low." RESULTS: In total, 154 patients underwent LLIF or MIS TLIF during the study period (33 TLIF high BMI, 45 TLIF low BMI, 28 LLIF high BMI, and 48 LLIF low BMI). Compared with TLIF high BMI patients, TLIF low BMI patients experienced superior posterior disc height restoration (P = 0.05), shorter operative duration (P = 0.01), decreased revision surgery rate (P = 0.02), reduced estimated blood loss (P = 0.04), and shorter hospital length of stay (P = 0.03). No differences in outcomes were seen in LLIF high BMI versus LLIF low BMI cohorts. Among obese patients, LLIF provided superior restoration in anterior disc height (P < 0.001), posterior disc height (P = 0.003), and neuroforaminal height (P = 0.002); shorter operative duration (P < 0.001); and decreased estimated blood loss (P = 0.008), compared with MIS TLIF. CONCLUSIONS: Obesity was associated with poorer overall radiographic and surgical outcomes after MIS TLIF but not LLIF. In obese patients in our cohort, LLIF provided superior improvements in spinopelvic parameters and surgical characteristics. BMI should be considered when deciding between LLIF and MIS TLIF.

Medical Subject Headings

Humans; Spinal Fusion (methods); Male; Female; Minimally Invasive Surgical Procedures (methods); Middle Aged; Obesity (complications, diagnostic imaging, surgery); Retrospective Studies; Lumbar Vertebrae (surgery, diagnostic imaging); Treatment Outcome; Aged; Body Mass Index; Adult; Length of Stay; Postoperative Complications (epidemiology)

Publication Date

3-1-2025

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

195

First Page

123691

PubMed ID

39826833

Digital Object Identifier (DOI)

10.1016/j.wneu.2025.123691

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