title: Comparison of Complications and Clinical and Radiographic Outcomes Between Nonobese and Obese Patients with Adult Spinal Deformity Undergoing Minimally Invasive Surgery.
abstract: OBJECTIVE
  Obesity can be associated with increased complications and potentially worse outcomes. We aimed to evaluate the impact of obesity on complications and outcomes in patients with adult spinal deformity (ASD) who underwent minimally invasive surgery (MIS).
  
  
  METHODS
  A multicenter database of patients with ASD treated via MIS was queried. Of 190 patients in the database, 77 fit the inclusion criteria of 3 or more spinal levels treated minimally invasively. Patients were divided by body mass index (BMI) <30 (nonobese; n = 59) and BMI ≥ 30 (obese; n = 18).
  
  
  RESULTS
  Mean BMI was 24.6 nonobese and 35.0 obese (P < 0.001). There were mean 3.8 interbody fusions nonobese and 4.7 obese (P = 0.065). Levels treated posteriorly averaged 5.8 nonobese and 5.9 obese (P = 0.502). Mean follow-up was 34.4 months nonobese and 35.3 months obese (P = 0.976). Baseline radiographic parameters were similar between groups. Postoperatively, SVA averaged 83.9 mm obese and 20.4 mm nonobese (P = 0.002). Postoperative lumbar lordosis-pelvic incidence mismatch averaged 17.9° obese and 9.9° nonobese (P = 0.028). Both groups had improvement in Oswestry Disability Index (ODI) scores with no difference in postoperative ODI scores between groups (P = 0.090). Similarly, both groups had decreased VAS scores for back and leg pain with no difference between groups postoperatively. Twenty (33.9%) nonobese patients versus 7 (38.9%) obese patients had complications (P = 0.452).
  
  
  CONCLUSIONS
  Our results suggest that obesity does not negatively impact complication rate or clinical outcomes in patients with ASD treated via MIS approaches.
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA. Electronic address: ppark@umich.edu.
authors.forename: Paul
authors.initials: P
authors.lastname: Park
authors.affiliation: Department of Neurological Surgery, University of Miami, Miami, Florida, USA.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Wang
authors.affiliation: San Diego Center for Spinal Disorders, La Jolla, California, USA.
authors.forename: Stacie
authors.initials: S
authors.lastname: Nguyen
authors.affiliation: San Diego Center for Spinal Disorders, La Jolla, California, USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Mundis
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: La Marca
authors.affiliation: Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
authors.forename: Juan S
authors.initials: JS
authors.lastname: Uribe
authors.affiliation: Cedars-Sinai Spine Center, Los Angeles, California, USA.
authors.forename: Neel
authors.initials: N
authors.lastname: Anand
authors.affiliation: Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: David O
authors.initials: DO
authors.lastname: Okonkwo
authors.affiliation: Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kanter
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Fessler
authors.affiliation: Department of Orthopaedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California, USA.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Eastlack
authors.affiliation: Department of Neurosurgery, University of California, San Francisco, California, USA.
authors.forename: Dean
authors.initials: D
authors.lastname: Chou
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, California, USA.
authors.forename: Vedat
authors.initials: V
authors.lastname: Deviren
authors.affiliation: Spine Institute of Louisiana, Shreveport, Louisiana, USA.
authors.forename: Pierce D
authors.initials: PD
authors.lastname: Nunley
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Department of Neurosurgery, University of California, San Francisco, California, USA.
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000209:etiology; D015992:Body Mass Index; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery; D008141:Lordosis / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D009139:Musculoskeletal Abnormalities / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013131:Spine / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Complications; Minimally invasive surgery; Obesity; Outcomes; Scoliosis; Spinal deformity