Obesity may be associated with adjacent-segment degeneration after single-level transforaminal lumbar interbody fusion in spinopelvic-mismatched patients with a minimum 2-year follow-up

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  • 1 Departments of Neurological Surgery and
  • 2 Orthopaedic Surgery, University of California, San Francisco, California; and
  • 3 Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
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OBJECTIVE

In this study, the authors’ aim was to investigate whether obesity affects surgery rates for adjacent-segment degeneration (ASD) after transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis.

METHODS

Patients who underwent single-level TLIF for spondylolisthesis at the University of California, San Francisco, from 2006 to 2016 were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, single-level TLIF, and degenerative lumbar spondylolisthesis. Exclusion criteria were trauma, tumor, infection, multilevel fusions, non-TLIF fusions, or less than a 2-year follow-up. Patient demographic data were collected, and an analysis of spinopelvic parameters was performed. The patients were divided into two groups: mismatched, or pelvic incidence (PI) minus lumbar lordosis (LL) ≥ 10°; and balanced, or PI-LL < 10°. Within the two groups, the patients were further classified by BMI (< 30 and ≥ 30 kg/m2). Patients were then evaluated for surgery for ASD, matched by BMI and PI-LL parameters.

RESULTS

A total of 190 patients met inclusion criteria (72 males and 118 females, mean age 59.57 ± 12.39 years). The average follow-up was 40.21 ± 20.42 months (range 24–135 months). In total, 24 patients (12.63% of 190) underwent surgery for ASD. Within the entire cohort, 82 patients were in the mismatched group, and 108 patients were in the balanced group. Within the mismatched group, adjacent-segment surgeries occurred at the following rates: BMI < 30 kg/m2, 2.1% (1/48); and BMI ≥ 30 kg/m2, 17.6% (6/34). Significant differences were seen between patients with BMI ≥ 30 and BMI < 30 (p = 0.018). A receiver operating characteristic curve for BMI as a predictor for ASD was established, with an AUC of 0.69 (95% CI 0.49–0.90). The optimal BMI cutoff value determined by the Youden index is 29.95 (sensitivity 0.857; specificity 0.627). However, in the balanced PI-LL group (108/190 patients), there was no difference in surgery rates for ASD among the patients with different BMIs (p > 0.05).

CONCLUSIONS

In patients who have a PI-LL mismatch, obesity may be associated with an increased risk of surgery for ASD after TLIF, but in obese patients without PI-LL mismatch, this association was not observed.

ABBREVIATIONS ASD = adjacent-segment degeneration; AUC = area under the ROC curve; LL = lumbar lordosis; PI = pelvic incidence; PI-LL = PI minus LL; PT = pelvic tilt; ROC = receiver operating characteristic; SS = sacral slope; TLIF = transforaminal lumbar interbody fusion.

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Contributor Notes

Correspondence Ping-Guo Duan: The First Affiliated Hospital of Nanchang University, Nanchang, China. pink1198@163.com.

INCLUDE WHEN CITING Published online October 9, 2020; DOI: 10.3171/2020.6.SPINE20159.

Disclosures Dr. Mummaneni: consultant for DePuy Synthes, Globus, and Stryker; direct stock ownership in Spinicity/ISD; royalties from DePuy Synthes, Thieme Publishers, and Springer Publishers; and grants from ISSG, NREF, and AO Spine. Dr. Chan: support of non–study-related clinical or research effort overseen by author. Dr. Berven: consultant for Green Sun Medical, Medtronic, Stryker, Globus, Medicrea, and Integrity. Dr. Chou: consultant for Globus and Medtronic, and royalties from Globus.

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