Skip to main content
Top
Published in: BMC Musculoskeletal Disorders 1/2018

Open Access 01-12-2018 | Research article

Minimally invasive versus open Transforaminal lumbar Interbody fusion in obese patients: a meta-analysis

Authors: Qingsong Xie, Jing Zhang, Feng Lu, Hao Wu, Zan Chen, Fengzeng Jian

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

Login to get access

Abstract

Background

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has been employed in increasing cases compared with open TLIF (Open-TLIF). However, it is uncertain whether the advantages of MI-TLIF can also be specifically applied in obese patients. Therefore, the current study was thereby carried out aiming to compare the outcomes of MI-TLIF with those of Open-TLIF in obese patients with lumbar degenerative diseases.

Methods

Electronic databases were systemically retrieved from construction to May 2017. Meanwhile, the odds ratio (OR), mean difference (MD) and 95% confidence intervals (CI) were determined.

Results

A total of 7 observational cohort studies were enrolled into the current meta-analysis. The results indicated that, compared with Open-TLIF group, MI-TLIF could remarkably reduce the operative time (P = 0.002), intraoperative blood loss (P < 0.001), postoperative drainage (P = 0.01), length of stay (P < 0.001) and incidence of complications (P < 0.001). In addition, MI-TLIF could also lead to markedly lower early back pain-Visual Analog Scale (BP-VAS) score than that of Open-TLIF (P < 0.001), but no statistically significant differences were found in Oswestry Disability Index (ODI), late BP-VAS, early leg pain-VAS (LP-VAS) and late LP-VAS scores.

Conclusion

MI-TLIF may be a more preferred choice for obese patients undergoing spinal surgery. However, differences in the long-term functional and pain outcomes between MI-TLIF and Open-TLIF remain a source of controversy, which should be further verified in future randomized-control trials.
Appendix
Available only for authorised users
Literature
1.
go back to reference Deyo RA, Bass JE. Lifestyle and low-back pain. The influence of smoking and obesity. Spine. 1989;14(5):501–6.CrossRefPubMed Deyo RA, Bass JE. Lifestyle and low-back pain. The influence of smoking and obesity. Spine. 1989;14(5):501–6.CrossRefPubMed
2.
go back to reference Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. The evidence report. National Institutes of Health. Obes Res. 1998;6(Suppl 2):51S–209S. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. The evidence report. National Institutes of Health. Obes Res. 1998;6(Suppl 2):51S–209S.
3.
go back to reference Sielatycki JA, Chotai S, Stonko D, Wick J, Kay H, McGirt MJ, Devin CJ. Is obesity associated with worse patient-reported outcomes following lumbar surgery for degenerative conditions? Eur Spine J. 2016;25(5):1627–33.CrossRefPubMed Sielatycki JA, Chotai S, Stonko D, Wick J, Kay H, McGirt MJ, Devin CJ. Is obesity associated with worse patient-reported outcomes following lumbar surgery for degenerative conditions? Eur Spine J. 2016;25(5):1627–33.CrossRefPubMed
4.
go back to reference Dario AB, Ferreira ML, Refshauge K, Sanchez-Romera JF, Luque-Suarez A, Hopper JL, Ordonana JR, Ferreira PH. Are obesity and body fat distribution associated with low back pain in women? A population-based study of 1128 Spanish twins. Eur Spine J. 2016;25(4):1188–95.CrossRefPubMed Dario AB, Ferreira ML, Refshauge K, Sanchez-Romera JF, Luque-Suarez A, Hopper JL, Ordonana JR, Ferreira PH. Are obesity and body fat distribution associated with low back pain in women? A population-based study of 1128 Spanish twins. Eur Spine J. 2016;25(4):1188–95.CrossRefPubMed
5.
go back to reference Vaidya R, Carp J, Bartol S, Ouellette N, Lee S, Sethi A. Lumbar spine fusion in obese and morbidly obese patients. Spine. 2009;34(5):495–500.CrossRefPubMed Vaidya R, Carp J, Bartol S, Ouellette N, Lee S, Sethi A. Lumbar spine fusion in obese and morbidly obese patients. Spine. 2009;34(5):495–500.CrossRefPubMed
6.
go back to reference Djurasovic M, Bratcher KR, Glassman SD, Dimar JR, Carreon LY. The effect of obesity on clinical outcomes after lumbar fusion. Spine. 2008;33(16):1789–92.CrossRefPubMed Djurasovic M, Bratcher KR, Glassman SD, Dimar JR, Carreon LY. The effect of obesity on clinical outcomes after lumbar fusion. Spine. 2008;33(16):1789–92.CrossRefPubMed
7.
go back to reference Patel N, Bagan B, Vadera S, Maltenfort MG, Deutsch H, Vaccaro AR, Harrop J, Sharan A, Ratliff JK. Obesity and spine surgery: relation to perioperative complications. Journal of neurosurgery Spine. 2007;6(4):291–7.CrossRefPubMed Patel N, Bagan B, Vadera S, Maltenfort MG, Deutsch H, Vaccaro AR, Harrop J, Sharan A, Ratliff JK. Obesity and spine surgery: relation to perioperative complications. Journal of neurosurgery Spine. 2007;6(4):291–7.CrossRefPubMed
8.
go back to reference McGuire KJ, Khaleel MA, Rihn JA, Lurie JD, Zhao W, Weinstein JN. The effect of high obesity on outcomes of treatment for lumbar spinal conditions: subgroup analysis of the spine patient outcomes research trial. Spine. 2014;39(23):1975–80.CrossRefPubMedPubMedCentral McGuire KJ, Khaleel MA, Rihn JA, Lurie JD, Zhao W, Weinstein JN. The effect of high obesity on outcomes of treatment for lumbar spinal conditions: subgroup analysis of the spine patient outcomes research trial. Spine. 2014;39(23):1975–80.CrossRefPubMedPubMedCentral
9.
go back to reference De la Garza-Ramos R, Bydon M, Abt NB, Sciubba DM, Wolinsky JP, Bydon A, Gokaslan ZL, Rabin B, Witham TF. The impact of obesity on short- and long-term outcomes after lumbar fusion. Spine. 2015;40(1):56–61.CrossRefPubMed De la Garza-Ramos R, Bydon M, Abt NB, Sciubba DM, Wolinsky JP, Bydon A, Gokaslan ZL, Rabin B, Witham TF. The impact of obesity on short- and long-term outcomes after lumbar fusion. Spine. 2015;40(1):56–61.CrossRefPubMed
10.
go back to reference Dhall SS, Wang MY, Mummaneni PV. Clinical and radiographic comparison of mini-open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up. J Neurosurg Spine. 2008;9(6):560–5.CrossRefPubMed Dhall SS, Wang MY, Mummaneni PV. Clinical and radiographic comparison of mini-open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up. J Neurosurg Spine. 2008;9(6):560–5.CrossRefPubMed
11.
go back to reference Lau D, Lee JG, Han SJ, Lu DC, Chou D. Complications and perioperative factors associated with learning the technique of minimally invasive transforaminal lumbar interbody fusion (TLIF). J Clin Neurosci. 2011;18(5):624–7.CrossRefPubMed Lau D, Lee JG, Han SJ, Lu DC, Chou D. Complications and perioperative factors associated with learning the technique of minimally invasive transforaminal lumbar interbody fusion (TLIF). J Clin Neurosci. 2011;18(5):624–7.CrossRefPubMed
12.
go back to reference Khan NR, Clark AJ, Lee SL, Venable GT, Rossi NB, Foley KT. Surgical outcomes for minimally invasive vs open Transforaminal lumbar Interbody fusion: an updated systematic review and meta-analysis. Neurosurgery. 2015;77(6):847–74. discussion 874CrossRefPubMed Khan NR, Clark AJ, Lee SL, Venable GT, Rossi NB, Foley KT. Surgical outcomes for minimally invasive vs open Transforaminal lumbar Interbody fusion: an updated systematic review and meta-analysis. Neurosurgery. 2015;77(6):847–74. discussion 874CrossRefPubMed
13.
go back to reference Goldstein CL, Macwan K, Sundararajan K, Rampersaud YR. Comparative outcomes of minimally invasive surgery for posterior lumbar fusion: a systematic review. Clin Orthop Relat Res. 2014;472(6):1727–37.CrossRefPubMedPubMedCentral Goldstein CL, Macwan K, Sundararajan K, Rampersaud YR. Comparative outcomes of minimally invasive surgery for posterior lumbar fusion: a systematic review. Clin Orthop Relat Res. 2014;472(6):1727–37.CrossRefPubMedPubMedCentral
14.
go back to reference Tian NF, Wu YS, Zhang XL, Xu HZ, Chi YL, Mao FM. Minimally invasive versus open transforaminal lumbar interbody fusion: a meta-analysis based on the current evidence. Eur Spine J. 2013;22(8):1741–9.CrossRefPubMedPubMedCentral Tian NF, Wu YS, Zhang XL, Xu HZ, Chi YL, Mao FM. Minimally invasive versus open transforaminal lumbar interbody fusion: a meta-analysis based on the current evidence. Eur Spine J. 2013;22(8):1741–9.CrossRefPubMedPubMedCentral
15.
go back to reference Skovrlj B, Belton P, Zarzour H, Qureshi SA. Perioperative outcomes in minimally invasive lumbar spine surgery: a systematic review. World J Orthod. 2015;6(11):996–1005.CrossRef Skovrlj B, Belton P, Zarzour H, Qureshi SA. Perioperative outcomes in minimally invasive lumbar spine surgery: a systematic review. World J Orthod. 2015;6(11):996–1005.CrossRef
16.
go back to reference Wang XS, Sun RF, Ji Q, Zhao B, Niu XM, Wang R, Peng L, Tian XD. A meta-analysis of interlaminar minimally invasive discectomy compared to conventional microdiscectomy for lumbar disk herniation. Clin Neurol Neurosurg. 2014;127:149–57.CrossRefPubMed Wang XS, Sun RF, Ji Q, Zhao B, Niu XM, Wang R, Peng L, Tian XD. A meta-analysis of interlaminar minimally invasive discectomy compared to conventional microdiscectomy for lumbar disk herniation. Clin Neurol Neurosurg. 2014;127:149–57.CrossRefPubMed
17.
go back to reference Phan K, Rao PJ, Mobbs RJ. Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: systematic review and meta-analysis of comparative studies. Clin Neurol Neurosurg. 2015;135:85–92.CrossRefPubMed Phan K, Rao PJ, Mobbs RJ. Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: systematic review and meta-analysis of comparative studies. Clin Neurol Neurosurg. 2015;135:85–92.CrossRefPubMed
18.
go back to reference Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefPubMedPubMedCentral Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefPubMedPubMedCentral
19.
go back to reference Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. Int J Obes Relat Metab Disord. 1998;22(1):39–47.CrossRefPubMed Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. Int J Obes Relat Metab Disord. 1998;22(1):39–47.CrossRefPubMed
20.
go back to reference Oremus M, Oremus C, Hall GB, McKinnon MC, Ect, Cognition Systematic Review T. Inter-rater and test-retest reliability of quality assessments by novice student raters using the Jadad and Newcastle-Ottawa scales. BMJ Open. 2012;2(4):e001368.CrossRefPubMedPubMedCentral Oremus M, Oremus C, Hall GB, McKinnon MC, Ect, Cognition Systematic Review T. Inter-rater and test-retest reliability of quality assessments by novice student raters using the Jadad and Newcastle-Ottawa scales. BMJ Open. 2012;2(4):e001368.CrossRefPubMedPubMedCentral
21.
go back to reference Deeks JJ. Issues in the selection of a summary statistic for meta-analysis of clinical trials with binary outcomes. Stat Med. 2002;21(11):1575–600.CrossRefPubMed Deeks JJ. Issues in the selection of a summary statistic for meta-analysis of clinical trials with binary outcomes. Stat Med. 2002;21(11):1575–600.CrossRefPubMed
22.
go back to reference Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.CrossRefPubMed Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.CrossRefPubMed
23.
go back to reference Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.CrossRefPubMed Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.CrossRefPubMed
24.
go back to reference Adogwa O, Carr K, Thompson P, Hoang K, Darlington T, Perez E, Fatemi P, Gottfried O, Cheng J, Isaacs RE. 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):860–6.CrossRefPubMed Adogwa O, Carr K, Thompson P, Hoang K, Darlington T, Perez E, Fatemi P, Gottfried O, Cheng J, Isaacs RE. 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):860–6.CrossRefPubMed
25.
go back to reference Lau D, Khan A, Terman SW, Yee T, La Marca F, Park P. Comparison of perioperative outcomes following open versus minimally invasive transforaminal lumbar interbody fusion in obese patients. Neurosurg Focus. 2013;35(2):E10.CrossRefPubMed Lau D, Khan A, Terman SW, Yee T, La Marca F, Park P. Comparison of perioperative outcomes following open versus minimally invasive transforaminal lumbar interbody fusion in obese patients. Neurosurg Focus. 2013;35(2):E10.CrossRefPubMed
26.
go back to reference Mao KY, Zhang Q, Shi T, Su XZ, Xiong S, Wang B, Gu TS, Liu JH, Zhang YB, Han ZC. Therapeutic effect comparison of minimally invasive surgery and open transforaminal lumbar interbody fusion in treatment of obese patients with lumbar intervertebral disc. Acad J Chin Pla Med School. 2015;7:643–646,657. Mao KY, Zhang Q, Shi T, Su XZ, Xiong S, Wang B, Gu TS, Liu JH, Zhang YB, Han ZC. Therapeutic effect comparison of minimally invasive surgery and open transforaminal lumbar interbody fusion in treatment of obese patients with lumbar intervertebral disc. Acad J Chin Pla Med School. 2015;7:643–646,657.
27.
go back to reference Terman SW, Yee TJ, Lau D, Khan AA, La Marca F, Park P. Minimally invasive versus open transforaminal lumbar interbody fusion: comparison of clinical outcomes among obese patients. J Neurosurg Spine. 2014;20(6):644–52.CrossRefPubMed Terman SW, Yee TJ, Lau D, Khan AA, La Marca F, Park P. Minimally invasive versus open transforaminal lumbar interbody fusion: comparison of clinical outcomes among obese patients. J Neurosurg Spine. 2014;20(6):644–52.CrossRefPubMed
28.
go back to reference Wang J, Zhou Y, Feng Zhang Z, Qing Li C, Jie Zheng W, Liu J. 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):202–6.CrossRefPubMed Wang J, Zhou Y, Feng Zhang Z, Qing Li C, Jie Zheng W, Liu J. 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):202–6.CrossRefPubMed
29.
go back to reference Wang YP, An JL, Sun YP, Ding WY, Shen Y, Zhang W. Comparison of outcomes between minimally invasive transforaminal lumbar interbody fusion and traditional posterior lumbar intervertebral fusion in obese patients with lumbar disk prolapse. Ther Clin Risk Manag. 2017;13:87–94.CrossRefPubMedPubMedCentral Wang YP, An JL, Sun YP, Ding WY, Shen Y, Zhang W. Comparison of outcomes between minimally invasive transforaminal lumbar interbody fusion and traditional posterior lumbar intervertebral fusion in obese patients with lumbar disk prolapse. Ther Clin Risk Manag. 2017;13:87–94.CrossRefPubMedPubMedCentral
30.
go back to reference Zhang Q, Mao KY, Wang B, Gu TS, Xiong S, Zhang YB, Han ZC, Wang YG, Xiao B. Clinical effects of minimally invasive transforaminal lumbar interbody fusion for obese ;patients with lumbar disc herniation in peri operation period. Int J Orthop. 2015;3:235–9. Zhang Q, Mao KY, Wang B, Gu TS, Xiong S, Zhang YB, Han ZC, Wang YG, Xiao B. Clinical effects of minimally invasive transforaminal lumbar interbody fusion for obese ;patients with lumbar disc herniation in peri operation period. Int J Orthop. 2015;3:235–9.
31.
go back to reference Lee JC, Jang HD, Shin BJ. Learning curve and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion: our experience in 86 consecutive cases. Spine. 2012;37(18):1548–57.CrossRefPubMed Lee JC, Jang HD, Shin BJ. Learning curve and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion: our experience in 86 consecutive cases. Spine. 2012;37(18):1548–57.CrossRefPubMed
32.
go back to reference Schizas C, Tzinieris N, Tsiridis E, Kosmopoulos V. Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. Int Orthop. 2009;33(6):1683–8.CrossRefPubMed Schizas C, Tzinieris N, Tsiridis E, Kosmopoulos V. Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. Int Orthop. 2009;33(6):1683–8.CrossRefPubMed
33.
go back to reference Shunwu F, Xing Z, Fengdong Z, Xiangqian F. Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine. 2010;35(17):1615–20.CrossRefPubMed Shunwu F, Xing Z, Fengdong Z, Xiangqian F. Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine. 2010;35(17):1615–20.CrossRefPubMed
34.
go back to reference Adogwa O, Parker SL, Bydon A, Cheng J, McGirt MJ. Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion: 2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech. 2011;24(8):479–84.PubMed Adogwa O, Parker SL, Bydon A, Cheng J, McGirt MJ. Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion: 2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech. 2011;24(8):479–84.PubMed
35.
go back to reference Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J. 2010;19(10):1780–4.CrossRefPubMedPubMedCentral Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J. 2010;19(10):1780–4.CrossRefPubMedPubMedCentral
36.
go back to reference Lu VM, Kerezoudis P, Gilder HE, McCutcheon BA, Phan K, Bydon M. Minimally invasive surgery versus open surgery spinal fusion for Spondylolisthesis: a systematic review and meta-analysis. Spine. 2017;42(3):E177–85.CrossRefPubMed Lu VM, Kerezoudis P, Gilder HE, McCutcheon BA, Phan K, Bydon M. Minimally invasive surgery versus open surgery spinal fusion for Spondylolisthesis: a systematic review and meta-analysis. Spine. 2017;42(3):E177–85.CrossRefPubMed
Metadata
Title
Minimally invasive versus open Transforaminal lumbar Interbody fusion in obese patients: a meta-analysis
Authors
Qingsong Xie
Jing Zhang
Feng Lu
Hao Wu
Zan Chen
Fengzeng Jian
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-018-1937-6

Other articles of this Issue 1/2018

BMC Musculoskeletal Disorders 1/2018 Go to the issue