Comparison of clinical outcomes of minimally invasive transforaminal lumber interbody fusion and posterior lumbar interbody fusion for lumbar disc herniation in obese patients

Abstract

Objective To compare the clinical outcomes of minimally invasive transforaminal lumber interbody fusion(MIS-TLIF) and posterior lumbar interbody fusion(PLIF) in obese patients (BMI≥28 kg/m2) with lumbar disk herniation(LDH). Methods A retrospective study of 62 obese patients from January 2009 to March 2014 with LDH was performed at the Third Hospital of Hebei Medical University. According to the surgical approach they underwent, 62 patients were divided into two groups, 32 underwent PLIF, and 30 underwent MIS-TLIF. Before surgery, there were no differences between MIS-TLIF group and PLIF group in terms of the level of serum creatine kinase (CK), visual analogue scale (VAS) scores, Oswestry disability index (ODI) and Japanese Orthopaedic Association (JOA) scores (all P values>0.05). All enrolled patients were followed up for 6 months after operation. The operative time, intraoperative blood loss, postoperative drainage volume and postoperative bedtime were recorded and compared. Meanwhile, the back pain VAS, ODI, JOA scores and serum CK level were also recorded and compared to evaluate the clinical effects. Postoperative complications were also recorded and compared between two groups. Results Compared with PLIF group, the operative time was longer than that in MIS-TLIF group, [(154±54)min vs (103±31)min, t'=4.489, P 0.05). At the 3- and 6- month follow-up, the mean JOA score in MIS-TLIF group was significantly higher than that in PLIF group (all P values<0.01). Three patients with delayed union(one patient had wound infection) in PLIF group, and there were no other complications in both groups. Conclusions Obese patients can achieve good efficacy with MIS-TLIF or PLIF treatment, but MIS-TLIF treatment shows shorter operation time, less trauma and bleeding volume, less incidence of short-term pain, low complication rate and faster postoperative recovery. Key words: Intervertebral disc displacement; Obesity; Surgical procedures, minimally invasive; Spinal fusion; Surgical complication