title: Less invasive posterior lumbar interbody fusion and obesity: clinical outcomes and return to work.
abstract: METHODS
  Single-center retrospective study.
  
  
  OBJECTIVE
  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.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Department of Spinal Surgery, University Hospital of North Tees, Stockton on Tees, TS19 8PE United Kingdom. singhanjani@hotmail.com
authors: Anjani K
authors: AK
authors: Singh
authors: Manju
authors: M
authors: Ramappa
authors: Chandra K
authors: CK
authors: Bhatia
authors: Manoj
authors: M
authors: Krishna
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control; D015992:Body Mass Index; D002908:Chronic Disease; D004185:Disability Evaluation; D017558:Elective Surgical Procedures; D004651:Employment; D004739:England; D005260:Female; D006801:Humans; D018868:Insurance, Disability; D007902:Length of Stay; D017116:Low Back Pain / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D010147:Pain Measurement; D020127:Recovery of Function; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014478:Unemployment