Orthopedics. 2022 Jul-Aug;45(4):203-208. doi: 10.3928/01477447-20220401-05. Epub 2022 Apr 6.
Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is an established technique for the treatment of degenerative spine disease. The larger body habitus of obese patients increases the intraoperative complexity of MI-TLIF. Therefore, it is unclear whether this procedure is appropriate for this population. The goal of this study was to compare postoperative outcomes for obese patients vs nonobese patients undergoing MI-TLIF through a matched cohort analysis. A retrospective review was performed to identify patients who underwent MI-TLIF at a single institution with a minimum follow-up of 5 years. Patients were divided into 2 cohorts: nonobese (body mass index <30 kg/m) and obese (body mass index ≥30 kg/m). Each cohort was matched for age, sex, and levels operated. Perioperative data and patient-reported outcomes were compared. Radiographic outcomes were measured at final follow-up. Standard binomial and categorical comparative analyses were performed. A total of 148 patients were included. Of obese patients, 17.6% required revision surgery compared with 16.2% of nonobese patients (=.826). Both cohorts had a similar proportion of pelvic incidence-lumbar lordosis mismatch correction (=.780). Mean change in functional outcome scores for each cohort did not differ significantly. Obese patients had clinically minor but statistically significantly greater blood loss and longer operative times than nonobese patients (<.001). Obese and non-obese patients undergoing MI-TLIF showed no long-term differences in revision rate, radiologic outcome, or functional outcome after long-term follow-up. Obese patients had slightly greater blood loss and longer operative times. Our findings suggest that MI-TLIF is an appropriate alternative to traditional open lumbar fusion for obese patients. [. 2022;45(4):203-208.].
微创经椎间孔腰椎体间融合术（MI-TLIF）是治疗退行性脊柱疾病的一种成熟技术。肥胖患者较大的体型增加了 MI-TLIF 的手术复杂性。因此，尚不清楚该手术是否适用于这一人群。本研究的目的是通过匹配队列分析比较肥胖患者和非肥胖患者接受 MI-TLIF 后的术后结果。对一家单机构接受 MI-TLIF 治疗且随访时间至少 5 年的患者进行回顾性研究。将患者分为两组：非肥胖组（体重指数<30 kg/m）和肥胖组（体重指数≥30 kg/m）。每组均按年龄、性别和手术节段进行匹配。比较围手术期数据和患者报告的结果。在最终随访时测量影像学结果。进行标准二项式和分类比较分析。共纳入 148 例患者。肥胖组中有 17.6%需要翻修手术，而非肥胖组中有 16.2%（= 0.826）。两组骨盆入射角-腰椎前凸角不匹配的矫正比例相似（= 0.780）。两组的功能结局评分的平均变化无显著差异。肥胖患者的出血量明显多于非肥胖患者，但差异无统计学意义（<.001），手术时间也明显长于非肥胖患者（<.001）。肥胖和非肥胖患者接受 MI-TLIF 后，在长期随访中，翻修率、影像学结果和功能结局均无明显差异。肥胖患者的出血量稍多，手术时间稍长。我们的研究结果表明，MI-TLIF 是肥胖患者传统开放式腰椎融合术的一种合适替代方法。[2022；45(4):203-208.]。
