{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:07:03Z","timestamp":1776096423788,"version":"3.50.1"},"reference-count":70,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,23]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Both minimally invasive (MI) and open surgical approaches can be effective for the treatment of degenerative lumbar spondylolisthesis (DLS). However, comparative effectiveness might be influenced by body mass index (BMI). The authors aimed to determine if there is a differential impact of open versus MI approaches on patient outcomes based on BMI.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n \n The authors performed a retrospective analysis of the prospective Quality Outcomes Database, identifying patients surgically treated for grade 1 DLS between July 2014 and June 2016. BMI was dichotomized into 2 groups: nonobese (BMI < 30 kg\/m\n 2<\/jats:sup>\n ) and obese (BMI \u2265 30 kg\/m\n 2<\/jats:sup>\n ) in accordance with the Centers for Disease Control and Prevention definition. The primary outcome was a minimal clinically important difference (MCID) in the Oswestry Disability Index (ODI). Secondary outcomes included an MCID in the EQ-5D, the North American Spine Society patient satisfaction index, an MCID in the numeric rating scale for leg pain (NRS-LP) and back pain (NRS-BP), surgical complications, discharge disposition, and reoperation. These variables were compared between surgical approaches and after subgrouping by BMI group. A nonroutine discharge was defined as discharge to any location other than home.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n Six hundred eight patients with grade 1 DLS were identified. Five hundred seventeen (85%) had 2-year follow-up for the primary outcome. There were 285 nonobese and 232 obese patients, and 216 patients underwent an MI approach and 301 underwent an open approach. Four hundred two patients (77.8%) underwent instrumented fusion, whereas 115 (22.2%) underwent decompression alone. Instrumented fusion was performed more frequently in the open group (81.7% vs 72.2%, \u03c7\n 2<\/jats:sup>\n = 6.03, p = 0.014) and in obese patients (83.6% vs 73.0%, \u03c7\n 2<\/jats:sup>\n = 7.76, p < 0.01). Regardless of surgical approach or BMI, 2-year (2Y) ODI (mean difference [MD] \u221223.4 \u00b1 20.38, p < 0.001), NRS-LP scores (MD \u22123.81 \u00b1 3.82, p < 0.001), and NRS-BP scores (MD \u22123.32 \u00b1 3.43, p < 0.0001), and EQ-5D scores (MD 0.21 \u00b1 0.24, p < 0.0001) improved from baseline. Among obese patients, the proportion attaining an MCID in 2Y ODI (73.3% vs 56.34%, \u03c7\n 2<\/jats:sup>\n = 6.11, p = 0.013) and EQ-5D (53.33% vs 37.32%, \u03c7\n 2<\/jats:sup>\n = 4.32, p = 0.038) was larger after MI than after open surgery; however, no differences were seen between MI and open surgery in the nonobese patients. There were no differences between MI and open approaches in either BMI group for the remaining secondary outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n \n Regardless of approach, patients improved following surgery for grade 1 DLS. Patients with BMI \u2265 30 kg\/m\n 2<\/jats:sup>\n had better long-term outcomes when treated with an MI surgical approach versus open surgery. This difference in outcomes between MI and open surgery was not observed among patients with BMI < 30 kg\/m\n 2<\/jats:sup>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.9.spine25552","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T17:11:56Z","timestamp":1770829916000},"page":"498-508","source":"Crossref","is-referenced-by-count":0,"title":["The comparative impact of body mass index on outcomes following minimally invasive versus open surgery for grade 1 spondylolisthesis: 2-year follow-up from the Quality Outcomes Database"],"prefix":"10.3171","volume":"44","author":[{"given":"Andr\u00e9s","family":"Pascual-Leone","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan F.","family":"Joiner","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dean","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erica F.","family":"Bisson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven D.","family":"Glassman","sequence":"additional","affiliation":[{"name":"Norton Leatherman Spine Center, Louisville, Kentucky;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin T.","family":"Foley","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee, Memphis, Tennessee;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric A.","family":"Potts","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Indiana University, Goodman Campbell Brain and Spine, Indianapolis, Indiana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Po","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domagoj","family":"Coric","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John J.","family":"Knightly","sequence":"additional","affiliation":[{"name":"Atlantic Neurosurgical Specialists, Morristown, New Jersey;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee, Memphis, Tennessee;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai-Ming","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Weill Cornell Medical College, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan R.","family":"Slotkin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Geisinger Health, Danville, Pennsylvania; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony L.","family":"Asher","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael S.","family":"Virk","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Weill Cornell Medical College, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Regis W.","family":"Haid","sequence":"additional","affiliation":[{"name":"Atlanta Brain and Spine Care, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew K.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Neurosurg Clin N Am","first-page":"299","article-title":"Degenerative lumbar spondylolisthesis","volume":"30","author":"Bydon M","year":"2019","unstructured":"Bydon M, Alvi MA, Goyal A. 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J Am Acad Orthop Surg. 2014;22(4):203\u2013213."},{"issue":"3","key":"b4","series-title":"J Orthopaed Traumatol","first-page":"128","article-title":"Surgical treatment of symptomatic degenerative lumbar spondylolisthesis by decompression and instrumented fusion","volume":"8","author":"Faldini C","year":"2007","unstructured":"Faldini C, Pagkrati S, Acri F, Miscione MT, Francesconi D, Giannini S. Surgical treatment of symptomatic degenerative lumbar spondylolisthesis by decompression and instrumented fusion. J Orthopaed Traumatol. 2007;8(3):128\u2013133."},{"issue":"24","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"2807","article-title":"Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation","volume":"22","author":"Fischgrund JS","year":"1997","unstructured":"Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT. 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Asian Spine J. 2022;16(6):1013\u20131021."},{"issue":"2","key":"b17","series-title":"J Neurosurg Spine","first-page":"182","article-title":"Leveraging machine learning to ascertain the implications of preoperative body mass index on surgical outcomes for 282 patients with preoperative obesity and lumbar spondylolisthesis in the Quality Outcomes Database","volume":"38","author":"Agarwal N","year":"2023","unstructured":"Agarwal N, Aabedi AA, Chan AK, Leveraging machine learning to ascertain the implications of preoperative body mass index on surgical outcomes for 282 patients with preoperative obesity and lumbar spondylolisthesis in the Quality Outcomes Database. 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J Neurosci Rural Pract. 2017;8(2):194\u2013198."},{"issue":"1","key":"b27","series-title":"J Orthop Surg Res","first-page":"150","article-title":"Comparison of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) with bilateral decompression via unilateral approach and open-TLIF with bilateral decompression for degenerative lumbar diseases: a retrospective cohort study","volume":"19","author":"Zhu F","year":"2024","unstructured":"Zhu F, Jia D, Zhang Y, Comparison of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) with bilateral decompression via unilateral approach and open-TLIF with bilateral decompression for degenerative lumbar diseases: a retrospective cohort study. 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Neurosurg Focus. 2023;54(1):E2."},{"issue":"12","key":"b31","series-title":"Spine J","first-page":"2049","article-title":"Long-term clinical outcome of minimally invasive versus open single-level transforaminal lumbar interbody fusion for degenerative lumbar diseases: a meta-analysis","volume":"21","author":"Heemskerk JL","year":"2021","unstructured":"Heemskerk JL, Oluwadara Akinduro O, Clifton W, Qui\u00f1ones-Hinojosa A, Abode-Iyamah KO. Long-term clinical outcome of minimally invasive versus open single-level transforaminal lumbar interbody fusion for degenerative lumbar diseases: a meta-analysis. Spine J. 2021;21(12):2049\u20132065."},{"issue":"6","key":"b32","series-title":"Global Spine J","first-page":"1602","article-title":"Minimally invasive vs. open surgery for lumbar spinal stenosis in patients with diabetes \u2013 a Canadian Spine Outcomes and Research Network study","volume":"13","author":"Hathi K","year":"2023","unstructured":"Hathi K, Bigney E, Richardson E, Minimally invasive vs. open surgery for lumbar spinal stenosis in patients with diabetes \u2013 a Canadian Spine Outcomes and Research Network study. Global Spine J. 2023;13(6):1602\u20131611."},{"issue":"6","key":"b33","series-title":"Oper Neurosurg","first-page":"565","article-title":"Patient frailty influences outcome after open, but not minimally invasive, transforaminal interbody fusion: a case series of 115 patients with lumbar degenerative disease","volume":"24","author":"Burke JF","year":"2023","unstructured":"Burke JF, Garcia JH, Safaee MM, Patient frailty influences outcome after open, but not minimally invasive, transforaminal interbody fusion: a case series of 115 patients with lumbar degenerative disease. Oper Neurosurg. 2023;24(6):565\u2013571."},{"issue":"2","key":"b34","series-title":"J Neurosurg Spine","first-page":"234","article-title":"Laminectomy alone versus fusion for grade 1 lumbar spondylolisthesis in 426 patients from the prospective Quality Outcomes Database","volume":"30","author":"Chan AK","year":"2019","unstructured":"Chan AK, Bisson EF, Bydon M, Laminectomy alone versus fusion for grade 1 lumbar spondylolisthesis in 426 patients from the prospective Quality Outcomes Database. J Neurosurg Spine. 2019;30(2):234\u2013241."},{"issue":"1","key":"b35","series-title":"J Neurosurg Spine","first-page":"42","article-title":"Patient-reported outcome improvements at 24-month follow-up after fusion added to decompression for grade I degenerative lumbar spondylolisthesis: a multicenter study using the Quality Outcomes Database","volume":"35","author":"Bisson EF","year":"2021","unstructured":"Bisson EF, Guan J, Bydon M, Patient-reported outcome improvements at 24-month follow-up after fusion added to decompression for grade I degenerative lumbar spondylolisthesis: a multicenter study using the Quality Outcomes Database. J Neurosurg Spine. 2021;35(1):42\u201351."},{"issue":"3","key":"b1","series-title":"Neurosurg Clin N Am","first-page":"299","article-title":"Degenerative lumbar spondylolisthesis","volume":"30","author":"Bydon M","year":"2019","unstructured":"Bydon M, Alvi MA, Goyal A. Degenerative lumbar spondylolisthesis. Neurosurg Clin N Am. 2019;30(3):299\u2013304."},{"key":"b2","series-title":"J Orthop Translat","first-page":"39","article-title":"Lumbar degenerative spondylolisthesis epidemiology: a systematic review with a focus on gender-specific and age-specific prevalence","volume":"11","author":"Wang YXJ","year":"2017","unstructured":"Wang YXJ, K\u00e1pl\u00e1r Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: a systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2017;11:39\u201352."},{"issue":"4","key":"b3","series-title":"J Am Acad Orthop Surg","first-page":"203","article-title":"Surgical management of lumbar degenerative spondylolisthesis","volume":"22","author":"Eismont FJ","year":"2014","unstructured":"Eismont FJ, Norton RP, Hirsch BP. Surgical management of lumbar degenerative spondylolisthesis. 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