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Is MIS-TLIF superior to open TLIF in obese patients?: A systematic review and meta-analysis

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Abstract

Purpose

Obesity is a global health problem. It increases the risk of surgical complications and re-operations. While both MIS-TLIF and O-TLIF are reported to have comparably good long-term outcomes for non-obese patients, no consensus has been reached for obese patients.

Methods

A comprehensive search of the published literature was performed: PubMed, Scopus, Web of Science and Cochrane Central Register of Controlled Trials database in accordance to the PRISMA 2009 checklist. Data were collected with attention to baseline demographics, intra-operative blood loss, duration of surgery, surgical complications, hospitalization stay, VAS and Oswestry disability index (ODI) pre- and postoperatively.

Results

A total of 863 abstracts were identified from the databases, of which 4 articles were included in the meta-analysis. A total of 430 patients were identified, of which 217(50.5%) underwent the O-TLIF, while 213(49.5%) underwent MIS-TLIF. One hundred and ninety-four (45.1%) patients were males, while 236(54.9%) were females. The average age was 54.8 ± 12.0 years. The pooled BMI was 33.4 ± 4.7 for the open-TLIF group, and 32.7 ± 3.9 for MIS-TLIF group (p = 0.22). When comparing O-TLIF to MIS-TLIF: Patients who underwent O-TLIF had 383 mls more blood loss (95% CI: 329.5–437.4, p < 0.00001), 1.2-day longer hospitalization stay (95% CI: 0.80–1.62, p < 0.00001) and 3.8 times higher risk of dural tear (95% CI: 1.61–9.87, p = 0.003) when compared to MIS-TLIF patients. A trend toward higher postoperative wound infection rates (O-TLIF: 4.5%, MIS-TLIF: 2.4%) and an inferior improvement in ODI score (O-TLIF: 39.3, MIS-TLIF: 44.1) was found in O-TLIF patients when compared to MIS-TLIF patients. However, these were not statistically significant.

Conclusion

MIS-TLIF is safe and may be a better option for lumbar fusion in obese patients.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Spine Centre, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Jun Hao Tan, Gabriel Liu, Ruimin Ng, Nishant Kumar, Hee-Kit Wong & Gabriel Liu

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  1. Jun Hao Tan
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Tan, J.H., Liu, G., Ng, R. et al. Is MIS-TLIF superior to open TLIF in obese patients?: A systematic review and meta-analysis. Eur Spine J 27, 1877–1886 (2018). https://doi.org/10.1007/s00586-018-5630-0

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