Less Invasive Posterior Lumbar Interbody Fusion and Obesity: Clinical Outcomes and Return to Work

Single-center retrospective study. The purpose of this study was to examine the relationship between obesity (body mass index [BMI] >30) and the incidence of perioperative complications, outcome of surgery, and return to work in a cohort of patients undergoing elective less invasive posterior lumbar interbody fusion (LI-PLIF) of the lumbar spine for low back pain and leg pain. Spine surgery in the obese is challenging and an increasing problem. There are few reported studies that have assessed the incidence of perioperative complications in obese patients undergoing elective lumbar fusion procedures. To our knowledge, the effect of obesity on LI-PLIF and return to work has not been evaluated in the published data. We identified 15 patients with BMI >30 who underwent LI-PLIF by reviewing the clinical notes and the preoperative admission sheet between April 2005 and March 2007. Patients who had suffered chronic low back pain for a minimum of 2 years that had proven unresponsive to conservative treatment were included. All patients underwent pre- and postoperative evaluations for Oswestry Disability Index, short-form 36, and visual analogue scores. Minimum follow-up was for 12 months. Blood loss was dependent on BMI, number of levels, and surgical time. Postoperative complication was 33.3%, which was more in the morbidly obese group than the in the obese group. Ten patients (66.6%) returned to their normal preoperative employment within 12 months of the index procedure. There was a significant improvement in the Oswestry Disability Index (14.78 ± 6.0, P = 0.03), in the visual analogue scores for back pain (3.2 ± 0.76, P = 0.001). Length of hospital stay was a mean of 3.35 days (range, 1-7). Surgical decision-making in the obese and morbidly obese patient is a challenge for the operating surgeon. Although surgery is technically more demanding, our experience with less invasive posterior interbody fusion has shown less incidence of postoperative complication, less intraoperative blood loss, and short in-patient hospital stay. Furthermore (66.6%) returned to their normal preoperative employment within 12 months of the index procedure. We conclude that a high BMI should not be a contraindication to surgery in patients with degenerative low back pain.