The effect of obesity on perioperative morbidity in oblique lumbar interbody fusion

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  • 1 Departments of Neurological Surgery and
  • 2 Orthopedic Surgery, and
  • 3 Division of Vascular Surgery, University of California, San Francisco, California; and
  • 4 Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China


Obese patients have been shown to have longer operative times and more complications from surgery. However, for obese patients undergoing minimally invasive surgery, these differences may not be as significant. In the lateral position, it is thought that obesity is less of an issue because gravity pulls the visceral fat away from the spine; however, this observation is primarily anecdotal and based on expert opinion. The authors performed oblique lumbar interbody fusion (OLIF) and they report on the perioperative morbidity in obese and nonobese patients.


The authors conducted a retrospective review of patients who underwent OLIF performed by 3 spine surgeons and 1 vascular surgeon at the University of California, San Francisco, from 2013 to 2018. Data collected included demographic variables; approach-related factors such as operative time, blood loss, and expected temporary approach-related sequelae; and overall complications. Patients were categorized according to their body mass index (BMI). Obesity was defined as a BMI ≥ 30 kg/m2, and severe obesity was defined as a BMI ≥ 35 kg/m2.


There were 238 patients (95 males and 143 females). There were no significant differences between the obese and nonobese groups in terms of sex, levels fused, or smoking status. For the entire cohort, there was no difference in operative time, blood loss, or complications when comparing obese and nonobese patients. However, a subset analysis of the 77 multilevel OLIFs that included L5–S1 demonstrated that the operative times for the nonobese group was 223.55 ± 57.93 minutes, whereas it was 273.75 ± 90.07 minutes for the obese group (p = 0.004). In this subset, the expected approach-related sequela rate was 13.2% for the nonobese group, whereas it was 33.3% for the obese group (p = 0.039). However, the two groups had similar blood loss (p = 0.476) and complication rates (p = 0.876).


Obesity and morbid obesity generally do not increase the operative time, blood loss, approach-related sequelae, or complications following OLIF. However, obese patients who undergo multilevel OLIF that includes the L5–S1 level do have longer operative times or a higher rate of expected approach-related sequelae. Obesity should not be considered a contraindication to multilevel OLIF, but patients should be informed of potentially increased morbidity if the L5–S1 level is to be included.

ABBREVIATIONS ALIF = anterior lumbar interbody fusion; BMI = body mass index; LLIF = lateral lumbar interbody fusion; MIS = minimally invasive surgery; OLIF = oblique lumbar interbody fusion.

Supplementary Materials

    • Supplemental Figure 1 (PDF 631 KB)

Contributor Notes

Correspondence Zhuo Xi: Shengjing Hospital of China Medical University, Liaoning Sheng, China.

INCLUDE WHEN CITING PUBLISHED online March 27, 2020; DOI: 10.3171/2020.1.SPINE191131.

Disclosures Dr. Burch reports being a consultant for Medtronic. Dr. Chou reports being a consultant for Medtronic and Globus; he receives royalties from Globus. Dr. Mummaneni reports being a consultant for DePuy Spine, Globus, and Stryker; he owns stock in Spinicity/ISD; he receives support for non–study-related clinical or research efforts that he oversees from NREF and from AOSpine; and he receives royalties from DePuy Spine, Thieme Publishers, and Springer Publishers.


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