Does minimally invasive spine surgery improve outcomes in the obese population? A retrospective review of 1442 degenerative lumbar spine surgeries

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  • 1 Georgetown University School of Medicine;
  • | 2 Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC; and
  • | 3 Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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OBJECTIVE

The effect of obesity on outcomes in minimally invasive surgery (MIS) approaches to posterior lumbar surgery is not well characterized. The authors aimed to determine if there was a difference in operative variables and complication rates in obese patients who underwent MIS versus open approaches in posterior spinal surgery, as well as between obese and nonobese patients undergoing MIS approaches.

METHODS

A retrospective review of all consecutive patients who underwent posterior lumbar surgery from 2013 to 2016 at a single institution was performed. The primary outcome measure was postoperative complications. Secondary outcome measures included estimated blood loss (EBL), operative time, the need for revision, and hospital length of stay (LOS); readmission and disposition were also reviewed. Obese patients who underwent MIS were compared with those who underwent an open approach. Additionally, obese patients who underwent an MIS approach were compared with nonobese patients. Bivariate and multivariate analyses were carried out between the groups.

RESULTS

In total, 423 obese patients (57.0% decompression and 43.0% fusion) underwent posterior lumbar MIS. When compared with 229 obese patients (56.8% decompression and 43.2% fusion) who underwent an open approach, patients in both the obese and nonobese groups who underwent MIS experienced significantly decreased EBL, LOS, operative time, and surgical site infections (SSIs). Of the nonobese patients, 538 (58.4% decompression and 41.6% fusion) underwent MIS procedures. When compared with nonobese patients, obese patients who underwent MIS procedures had significantly increased LOS, EBL, operative time, revision rates, complications, and readmissions in the decompression group. In the fusion group, only LOS and disposition were significantly different.

CONCLUSIONS

Obese patients have poorer outcomes after posterior lumbar MIS when compared with nonobese patients. The use of an MIS technique can be of benefit, as it decreased EBL, operative time, LOS, and SSIs for posterior decompression with or without instrumented fusion in obese patients.

ABBREVIATIONS

dMIS = MIS decompression; dOpen = open decompression; DVT = deep vein thrombosis; EBL = estimated blood loss; fMIS = MIS fusion; fOpen = open fusion; LOS = length of stay; MIS = minimally invasive surgery; NO-dMIS = nonobese patients undergoing dMIS; NO-dOpen = nonobese patients undergoing dOpen; NO-fMIS = nonobese patients undergoing fMIS; NO-fOpen = nonobese patients undergoing fOpen; O-dMIS = obese patients undergoing dMIS; O-dOpen = obese patients undergoing dOpen; O-fMIS = obese patients undergoing fMIS; O-fOpen = obese patients undergoing fOpen; PE = pulmonary embolus; PNA = pneumonia; SSI = surgical site infection; TLIF = transforaminal lumbar interbody fusion; UTI = urinary tract infection.

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Contributor Notes

Correspondence Jean-Marc Voyadzis: MedStar Georgetown University Hospital, Washington, DC. jmvoyadzis@gmail.com.

INCLUDE WHEN CITING Published online July 16, 2021; DOI: 10.3171/2021.1.SPINE201785.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief. 2017;(288):18.

    • Search Google Scholar
    • Export Citation
  • 2

    Jackson KL II, Devine JG. The effects of obesity on spine surgery: a systematic review of the literature. Global Spine J. 2016;6(4):394400.

    • Search Google Scholar
    • Export Citation
  • 3

    Sheng B, Feng C, Zhang D, et al. Associations between obesity and spinal diseases: a medical expenditure panel study analysis. Int J Environ Res Public Health. 2017;14(2):111.

    • Search Google Scholar
    • Export Citation
  • 4

    Wilson Zingg R, Kendall R. Obesity, vascular disease, and lumbar disk degeneration: associations of comorbidities in low back pain. PM R. 2017;9(4):398402.

    • Search Google Scholar
    • Export Citation
  • 5

    Heuch I, Heuch I, Hagen K, Zwart JA. Body mass index as a risk factor for developing chronic low back pain: a follow-up in the Nord-Trøndelag Health Study. Spine (Phila Pa 1976). 2013;38(2):133139.

    • Search Google Scholar
    • Export Citation
  • 6

    Manchikanti L, Singh V, Falco FJE, et al. Epidemiology of low back pain in adults. Neuromodulation. 2014;17(suppl 2):310.

  • 7

    Samartzis D, Karppinen J, Cheung JPY, Lotz J. Disk degeneration and low back pain: are they fat-related conditions?. Global Spine J. 2013;3(3):133144.

    • Search Google Scholar
    • Export Citation
  • 8

    Rodriguez-Martinez NG, Perez-Orribo L, Kalb S, et al. The role of obesity in the biomechanics and radiological changes of the spine: an in vitro study. J Neurosurg Spine. 2016;24(4):615623.

    • Search Google Scholar
    • Export Citation
  • 9

    Kalichman L, Guermazi A, Li L, Hunter DJ. Association between age, sex, BMI and CT-evaluated spinal degeneration features. J Back Musculoskeletal Rehabil. 2009;22(4):189195.

    • Search Google Scholar
    • Export Citation
  • 10

    Liuke M, Solovieva S, Lamminen A, et al. Disc degeneration of the lumbar spine in relation to overweight. Int J Obes. 2005;29(8):903908.

  • 11

    Heliövaara M, Knekt P, Aromaa A. Incidence and risk factors of herniated lumbar intervertebral disc or sciatica leading to hospitalization. J Chronic Dis. 1987;40(3):251258.

    • Search Google Scholar
    • Export Citation
  • 12

    Hruby A, Hu FB. The epidemiology of obesity: a big picture. Pharmacoeconomics. 2015;33(7):673689.

  • 13

    Skovrlj B, Belton P, Zarzour H, Qureshi SA. Perioperative outcomes in minimally invasive lumbar spine surgery: a systematic review. World J Orthop. 2015;6(11):9961005.

    • Search Google Scholar
    • Export Citation
  • 14

    Xie L, Wu WJ, Liang Y. Comparison between minimally invasive transforaminal lumbar interbody fusion and conventional open transforaminal lumbar interbody fusion: an updated meta-analysis. Chin Med J (Engl). 2016;129(16):19691986.

    • Search Google Scholar
    • Export Citation
  • 15

    Altshuler M, Mueller KB, MacConnell A, et al. Reoperation, readmission, and discharge disposition for patients with degenerative lumbar pathology treated with either open or minimally invasive techniques: a single-center retrospective review of 1435 cases. Neurosurgery. 2020;87(6):11991205.

    • Search Google Scholar
    • Export Citation
  • 16

    Altshuler M, Mueller K, MacConnell A, Wirth P, Sandhu F, Voyadzis JM. Does minimally invasive spine surgery reduce the rate of perioperative medical complications? A retrospective single-center experience of 1435 degenerative lumbar spine surgeries. Eur Spine J. Published online July 22, 2020. 10.1007/s00586-020-06536-y

    • Search Google Scholar
    • Export Citation
  • 17

    Tjeertes EKM, Hoeks SE, Beks SBJ, et al. Obesity – a risk factor for postoperative complications in general surgery?. BMC Anesthesiol. 2015;15:112.

    • Search Google Scholar
    • Export Citation
  • 18

    Kadry B, Press CD, Alosh H, et al. Obesity increases operating room times in patients undergoing primary hip arthroplasty: a retrospective cohort analysis. PeerJ. 2014;2(1):e530.

    • Search Google Scholar
    • Export Citation
  • 19

    Bowditch MG, Villar RN. Do obese patients bleed more? A prospective study of blood loss at total hip replacement. Ann R Coll Surg Engl. 1999;81(3):198200.

    • Search Google Scholar
    • Export Citation
  • 20

    Wang J, Zhou Y, Feng Zhang Z, et al. Comparison of the clinical outcome in overweight or obese patients after minimally invasive versus open transforaminal lumbar interbody fusion. J Spinal Disord Tech. 2014;27(4):202206.

    • Search Google Scholar
    • Export Citation
  • 21

    Terman SW, Yee TJ, Lau D, et al. Minimally invasive versus open transforaminal lumbar interbody fusion: comparison of clinical outcomes among obese patients. J Neurosurg Spine. 2014;20(6):644652.

    • Search Google Scholar
    • Export Citation
  • 22

    Othman YA, Alhammoud A, Aldahamsheh O, et al. Minimally invasive spine lumbar surgery in obese patients: a systematic review and meta-analysis. HSS J. 2020;16(2):168176.

    • Search Google Scholar
    • Export Citation
  • 23

    Adogwa O, Carr K, Thompson P, et al. A prospective, multi-institutional comparative effectiveness study of lumbar spine surgery in morbidly obese patients: does minimally invasive transforaminal lumbar interbody fusion result in superior outcomes?. World Neurosurg. 2015;83(5):860866.

    • Search Google Scholar
    • Export Citation
  • 24

    Rosen DS, Ferguson SD, Ogden AT, et al. Obesity and self-reported outcome after minimally invasive lumbar spinal fusion surgery. Neurosurgery. 2008;63(5):956960.

    • Search Google Scholar
    • Export Citation
  • 25

    Park P, Wang MY, Nguyen S, et al. Comparison of complications and clinical and radiographic outcomes between nonobese and obese patients with adult spinal deformity undergoing minimally invasive surgery. World Neurosurg. 2016;87:5560.

    • Search Google Scholar
    • Export Citation
  • 26

    Seicean A, Alan N, Seicean S, et al. Impact of increased body mass index on outcomes of elective spinal surgery. Spine (Phila Pa 1976). 2014;39(18):15201530.

    • Search Google Scholar
    • Export Citation
  • 27

    Tomasino A, Parikh K, Steinberger J, et al. Tubular microsurgery for lumbar discectomies and laminectomies in obese patients: operative results and outcome. Spine (Phila Pa 1976). 2009;34(18):E664E672.

    • Search Google Scholar
    • Export Citation
  • 28

    Wang T, Han C, Jiang H, Tian P. The effect of obesity on clinical outcomes after minimally invasive surgery of the spine: a systematic review and meta-analysis. World Neurosurg. 2018;110:e438e449.

    • Search Google Scholar
    • Export Citation
  • 29

    Chan AK, Bisson EF, Bydon M, et al. Obese patients benefit, but do not fare as well as nonobese patients, following lumbar spondylolisthesis surgery: an analysis of the quality outcomes database. Neurosurgery. 2020;86(1):8087.

    • Search Google Scholar
    • Export Citation
  • 30

    Beack JY, Chun HJ, Bak KH, et al. Risk factors of secondary lumbar discectomy of a herniated lumbar disc after lumbar discectomy. J Korean Neurosurg Soc. 2019;62(5):586593.

    • Search Google Scholar
    • Export Citation
  • 31

    Fotakopoulos G, Makris D, Kotlia P, et al. Recurrence is associated with body mass index in patients undergoing a single-level lumbar disc herniation surgery. J Clin Med Res. 2018;10(6):486492.

    • Search Google Scholar
    • Export Citation
  • 32

    Meredith DS, Huang RC, Nguyen J, Lyman S. Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy. Spine J. 2010;10(7):575580.

    • Search Google Scholar
    • Export Citation
  • 33

    Senker W, Stefanits H, Gmeiner M, et al. Does obesity affect perioperative and postoperative morbidity and complication rates after minimal access spinal technologies in surgery for lumbar degenerative disc disease. World Neurosurg. 2018;111:e374e385.

    • Search Google Scholar
    • Export Citation
  • 34

    Buyuk AF, Shafa E, Dawson JM, Schwender JD. Complications with minimally invasive transforaminal lumbar interbody fusion for degenerative spondylolisthesis in the obese population. Spine (Phila Pa 1976). 2019;44(23):E1401E1408.

    • Search Google Scholar
    • Export Citation
  • 35

    Zheng F, Cammisa FP Jr, Sandhu HS, et al. Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. Spine (Phila Pa 1976). 2002;27(8):818824.

    • Search Google Scholar
    • Export Citation
  • 36

    Lee T-C, Yang L-C, Chen HJ. Effect of patient position and hypotensive anesthesia on inferior vena caval pressure. Spine (Phila Pa 1976). 1998;23(8):941948.

    • Search Google Scholar
    • Export Citation
  • 37

    Mueller K, Zhao D, Johnson O, et al. The difference in surgical site infection rates between open and minimally invasive spine surgery for degenerative lumbar pathology: a retrospective single center experience of 1442 cases. Oper Neurosurg (Hagerstown). 2019;16(6):750755.

    • Search Google Scholar
    • Export Citation
  • 38

    Goyal A, Elminawy M, Kerezoudis P, et al. Impact of obesity on outcomes following lumbar spine surgery: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2019;177(177):2736.

    • Search Google Scholar
    • Export Citation
  • 39

    Stevens KJ, Spenciner DB, Griffiths KL, et al. Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies. J Spinal Disord Tech. 2006;19(2):7786.

    • Search Google Scholar
    • Export Citation
  • 40

    Lau D, Khan A, Terman SW, et al. Comparison of perioperative outcomes following open versus minimally invasive transforaminal lumbar interbody fusion in obese patients. Neurosurg Focus. 2013;35(2):E10.

    • Search Google Scholar
    • Export Citation
  • 41

    Smith ZA, Nixon AT, Lawton CD, et al. Minimally invasive surgery for lumbar decompression in obese patients. J Spine. 2014;3(5):16.

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