Is There a Safer Spinal Fusion Option for Overweight Patients?

Almost 40% of the US population is obese¹. This means that these individuals have a body mass index (BMI) of 30 or above. We know that those who are significantly overweight are predisposed to a host of health issues—and back pain is definitely one of them. Studies have shown a strong association between obesity and lower back pain². Even worse, the excess weight that these patients carry traps them in a cruel cycle where the pain keeps them from exercising, making it even harder for them to lose weight.

Obesity and Spinal Fusion

When conservative treatments, such as pain medication and physical therapy, aren’t enough, surgery may offer an answer. But, once again, weight gets in the way. Obese patients are at significantly higher risk for postoperative complications, which include greater blood loss and a higher rate of postoperative infection. As a result, obese patients often shy away from spinal surgery. To be fair, some surgeons also decline to operate on these patients not only because of the risks but because of the technical difficulties that operating on an obese patient present.

Traditional Spinal Surgery

Lumbar fusion has been the go-to surgical procedure for degenerative spine conditions, but lumbar fusion can be accomplished through several different surgical techniques. For example, transforaminal lumbar interbody fusion (TLIF) is a traditional “open” surgery. It involves a deep incision and retractors that pull muscle and tissue apart to expose the spine so that the surgeon can view it directly. Since 2005, minimally invasive TLIF (MIS-TLIF) has offered a less invasive alternative. More recently, a newer minimally invasive surgical technique — OLLIF — can be performed through an incision that is no bigger than a dime.

OLLIF is Dramatically Safer for Overweight Patients

A recent research study — led by Hamid Abbasi, MD, PhD, FACS, FAANS, and chief medical officer at Inspired Spine — is painting an optimistic picture for overweight patients who need back surgery. The study looked at how overweight patients who underwent OLLIF surgery fared compared to those who had TLIF and MIS-TLIF surgery. All of the patients in the study had a BMI of 20 or greater. Patients included those with degenerative disc disease, spondylolisthesis, spondylosis, herniation, stenosis, and scoliosis. Sixty-eight patients who underwent OLLIF surgery were studied along with 225 who had TLIF and 28 patients who had MIS-TLIF surgery. The study compared the relationship between the type of surgery performed, the length of time required to perform the surgery, blood loss, and hospital stay.

The study showed that OLLIF was clearly the safest option for patients with a high BMI. No other spinal fusion technique has been able to offer this assurance.

Those patients who had OLLIF surgery had significantly shorter surgeries, less blood loss, and shorter hospital stays compared to TLIF and MIS-TLIF. Surgery time is associated with increased blood loss, complications, and costs. So shortening this time means more positive outcomes for the patient. With OLLIF, average surgery time was cut by 64% and 61% over TLIF and MIS-TLIF, respectively. (See the graph that follows.) Average blood loss dropped by 60% and 48% over TLIF and MIS-TLIF, respectively, and average hospital stay was decreased by 52% and 41%, respectively.

As shown in this graph, surgery time for patients having OLLIF surgery is significantly shorter than with TLIF or MIS-TLIF. Also significant: Surgery time did not increase for patients with a BMI of 30 or greater.

To learn more about OLLIF spinal fusion, contact the surgeons at Inspired Spine.

REFERENCES

1. https://www.cdc.gov/obesity/data/adult.html
2. https://www.verywellhealth.com/obesity-and-back-pain-297008