The rapeutic effect comparison of minimally invasive surgery and open transforaminal lumbar interbody fusion in treatment of obese patients with lumbar intervertebral disc

Objective To study the clinical curative effect of minimally invasive transforaminal lumbar interbody fusion （TLIF） and open transforaminal lumbar interbody fusion （Open-TILF） on obesity patients （BMI＞ 30 kg/m²） with lumbar disc herniation. Methods Clinical data about 79 obese patients （BMI＞ 30 kg/m²） with lumbar disc herniation admitted to our hospital from January 2011 to December 2013 were retrospectively analyzed. Patients had undergone MIS-TLIF and Open-TILF treatment and they were divided into MIS-TLIF group （n=46） and Open-TILF group （n=33）. The JOA， VAS and ODI score were applied to evaluate the clinical curative effect，average operation time， intraoperative bleeding volume， length of incision， ambulation time， average hospitalization and complications of patients in two groups. Results No significant differences were found in general data of patients in two groups before operation （P＞ 0.05）. Immediate postoperative X-ray films showed good position of internal fixator. In Open-TILF group， the amount of hemorrhage was （420±86） ml， incision length was （80±40） mm， postoperative ambulation time was （4.2±2.21） d， the average days in hospital were（9.3±3.40） d， and the average complication rate was 8%. While in MIS-TLIF group， the amount of hemorrhage was （110.83±50.51） ml，incision length was （2.5±0.18） cm， postoperative ambulation time was （24.37±8.50） h， the average hospitalization time was （5.0±2.52）d， and complication rate was 6.15%， all of which were significantly less than Open-TILF group （P＜ 0.05）. The JOA， VAS， ODI scores of MIS-TLIF group were higher than that of Open-TILF group in 3 days， 1 month， 3 months， 6 months after operation （P＜ 0.05）， while the complication rate of MIS-TLIF group was significantly lower than Open-TILF group （P＜ 0.05）. All patients were followed up for more than 6 months. X-ray examination showed no loosening， fracture or shift of pedicle screw internal fixation system. Conclusion Obese patients can achieve good efficacy with MIS-TLIF or Open-TILF treatment， but MIS-TLIF treatment shows shorter operation time，less trauma and bleeding volume， lower incidence of short-term pain， lower complication rate and faster postoperative recovery.