{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:01:15Z","timestamp":1780736475189,"version":"3.54.1"},"reference-count":70,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>Minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) has proven to be effective in the treatment of spondylolisthesis and degenerative disc disease (DDD). Compared with the traditional open TLIF, the MI procedure has been associated with less blood loss, less postoperative pain, and a shorter hospital stay. However, it is uncertain whether the advantages of an MI TLIF also apply specifically to obese patients. This study was dedicated to evaluating whether obese patients reap the perioperative benefits similar to those seen in patients with normal body mass index (BMI) when undergoing MI TLIF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Obese patients\u2014that is, those with a BMI of at least 30 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      \u2014who had undergone single-level TLIF were retrospectively identified and categorized according to BMI: Class I obesity, BMI 30.0\u201334.9 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ; Class II obesity, BMI 35.0\u201339.9 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ; or Class III obesity, BMI \u2265 40.0 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . In each obesity class, patients were stratified by TLIF approach, that is, open versus MI. Perioperative outcomes, including intraoperative estimated blood loss (EBL), complications (overall, intraoperative, and 30-day postoperative), and hospital length of stay (LOS), were compared. The chi-square test, Fisher exact test, or 2-tailed Student t-test were used when appropriate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One hundred twenty-seven patients were included in the final analysis; 49 underwent open TLIF and 78 underwent MI TLIF. Sixty-one patients had Class I obesity (23 open and 38 MI TLIF); 45 patients, Class II (19 open and 26 MI); and 21 patients, Class III (7 open and 14 MI). Overall, mean EBL was 397.2 ml and mean hospital LOS was 3.7 days. Minimally invasive TLIF was associated with significantly less EBL and a shorter hospital stay than open TLIF when all patients were evaluated as a single cohort and within individual obesity classes. Overall, the complication rate was 18.1%. Minimally invasive TLIF was associated with a significantly lower total complication rate (11.5% MI vs 28.6% open) and intraoperative complication rate (3.8% MI vs 16.3% open) as compared with open TLIF. When stratified by obesity class, MI TLIF was still associated with lower rates of total and intraoperative complications. This effect was most profound and statistically significant in patients with Class III obesity (42.9% open vs 7.1% MI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Minimally invasive TLIF offers obese patients perioperative benefits similar to those seen in patients with normal BMI who undergo the same procedure. These benefits include less EBL, a shorter hospital stay, and potentially fewer complications compared with open TLIF. Additional large retrospective studies and randomized prospective studies are needed to verify these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2013.5.focus13154","type":"journal-article","created":{"date-parts":[[2013,8,1]],"date-time":"2013-08-01T09:59:17Z","timestamp":1375351157000},"page":"E10","source":"Crossref","is-referenced-by-count":54,"title":["Comparison of perioperative outcomes following open versus minimally invasive transforaminal lumbar interbody fusion in obese patients"],"prefix":"10.3171","volume":"35","author":[{"given":"Darryl","family":"Lau","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Khan","sequence":"additional","affiliation":[{"name":"University of Michigan Medical School and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel W.","family":"Terman","sequence":"additional","affiliation":[{"name":"University of Michigan Medical School and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Yee","sequence":"additional","affiliation":[{"name":"University of Michigan Medical School and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"La Marca","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0350010","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1227\/01.NEU.0000298903.63635.E3","article-title":"Increased prevalence of obesity and obesity-related postoperative complications in male patients with meningiomas","volume":"61","author":"Aghi","year":"2007"},{"key":"b2-0350010","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1625","DOI":"10.1056\/NEJMoa021423","article-title":"Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults","volume":"348","author":"Calle","year":"2003"},{"key":"b3-0350010","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1056\/NEJM199910073411501","article-title":"Body-mass index and mortality in a prospective cohort of U.S. adults","volume":"341","author":"Calle","year":"1999"},{"key":"b4-0350010","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"560","DOI":"10.3171\/SPI.2008.9.08142","article-title":"Clinical and radiographic comparison of mini-open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up. 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