Garcia Rafael A, Odland Kari, Sembrano Jonathan
Orthopedic Surgery, University of Minnesota, Minneapolis, USA.
Cureus. 2025 Jun 23;17(6):e86582. doi: 10.7759/cureus.86582. eCollection 2025 Jun.
Lumbar spondylolisthesis often causes pain and disability, requiring surgical intervention. While prior studies explore the impact of body mass index (BMI) on outcomes following lumbar fusion, the effect of different surgical approaches, specifically transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF), across BMI categories remains unclear. This study evaluates patient-reported outcomes (PROs) following TLIF and LLIF in low-grade degenerative and isthmic spondylolisthesis, focusing on BMI stratification.
This study retrospectively analyzes patients with low-grade degenerative and isthmic spondylolisthesis who underwent lumbar fusion between 2010 and 2023. Patients were stratified by BMI into the following four groups: non-obese (<30), class I (30-34.9), class II (35-39.9), and class III (≥40). It assesses PROs using the Oswestry Disability Index (ODI) and visual analog scale (VAS) for pain at baseline and 12 months, comparing the achievement of minimal clinically important difference (MCID) between TLIF and LLIF.
This analysis included 72 patients showing significant improvements in ODI (mean change: 17.0; p<0.001) and VAS (mean change: 2.3; p<0.001) scores across all BMI categories at 12 months. TLIF and LLIF achieve similar rates of MCID, with no statistically significant differences between the surgical approaches (p=0.72). Non-obese and class II patients maintain sustained improvements.
Lumbar fusion using both open and minimally invasive (MIS) TLIF and LLIF leads to significant disability reduction across BMI categories, indicating that obesity does not contraindicate lumbar fusion. Surgical approach selection should focus on individual patient factors rather than BMI alone. Prospective studies with extended follow-up will further clarify the long-term impact of these approaches.
腰椎滑脱常导致疼痛和功能障碍，需要手术干预。虽然先前的研究探讨了体重指数（BMI）对腰椎融合术后疗效的影响，但不同手术方式，特别是经椎间孔腰椎椎间融合术（TLIF）和外侧腰椎椎间融合术（LLIF）在不同BMI类别中的效果仍不明确。本研究评估了TLIF和LLIF治疗低度退行性和峡部裂性腰椎滑脱后的患者报告结局（PROs），重点关注BMI分层。
本研究回顾性分析了2010年至2023年间接受腰椎融合术的低度退行性和峡部裂性腰椎滑脱患者。患者按BMI分层为以下四组：非肥胖（<30）、I类（30 - 34.9）、II类（35 - 39.9）和III类（≥40）。使用Oswestry功能障碍指数（ODI）和视觉模拟量表（VAS）评估基线和12个月时的疼痛情况，比较TLIF和LLIF之间达到最小临床重要差异（MCID）的情况。
本分析纳入了72例患者，所有BMI类别在12个月时ODI（平均变化：17.0；p<0.001）和VAS（平均变化：2.3；p<0.001）评分均有显著改善。TLIF和LLIF达到MCID的比例相似，手术方式之间无统计学显著差异（p = 0.72）。非肥胖和II类患者保持持续改善。
采用开放和微创（MIS）的TLIF和LLIF进行腰椎融合术可显著降低所有BMI类别患者的功能障碍，表明肥胖并非腰椎融合术的禁忌证。手术方式的选择应侧重于个体患者因素，而非仅考虑BMI。延长随访的前瞻性研究将进一步阐明这些手术方式的长期影响。
