Is Body Mass Index a Risk Factor for Revision Procedures After Minimally Invasive Transforaminal Lumbar Interbody Fusion?

Clin Spine Surg. 2018 Feb;31(1):E85-E91. doi: 10.1097/BSD.0000000000000547.


Study design: Retrospective cohort study.

Objective: To determine if an association exists between body mass index (BMI) and the rate of revision surgery after single-level minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of background data: MIS TLIF is an effective treatment for lumbar degenerative disease. Previous studies in the orthopedic literature have associated increased BMI with increased postoperative complications and need for revision. Few studies have evaluated the association between BMI and the risk for revision after minimally invasive spinal procedures.

Materials and methods: A surgical registry of patients who underwent a single-level MIS TLIF for degenerative pathology between 2005 and 2014 was reviewed. Patients were stratified based on BMI category: normal weight (BMI<25), overweight (BMI, 25-29.9), obese I (BMI, 30-34.9), and obese II-III (BMI≥35). BMI category was tested for association with demographic and procedural characteristics using 1-way analysis of variance (ANOVA) for continuous variables, and χ analysis or the Fisher exact test for categorical variables. BMI category was tested for association with undergoing a revision fusion procedure within 2 years after MIS TLIF using multivariate Cox proportional hazards survival analysis modeling.

Results: In total, 274 patients were analyzed; of these, 52 (18.98%) were normal weight, 101 (36.86%) were overweight, 62 (22.63%) were obese I, and 59 (21.53%) were obese II-III. On multivariate Cox proportional hazards survival analysis modeling, BMI category was not associated with undergoing a revision procedure within 2 years after MIS TLIF (P=0.599). On multivariate analysis, younger age (P=0.004) was associated with increased risk of undergoing a revision after MIS TLIF.

Conclusions: The results of this study suggest that increasing BMI is not a risk factor for undergoing a revision procedure after MIS TLIF. As such, patients with high BMI should be counseled regarding having similar rates of needing a revision procedure after MIS TLIF as those with lower BMI.

Level of evidence: Level IV.

MeSH terms

  • Body Mass Index*
  • Female
  • Humans
  • Intervertebral Disc / surgery*
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / surgery*
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures*
  • Multivariate Analysis
  • Perioperative Care
  • Postoperative Care
  • Proportional Hazards Models
  • Reoperation*
  • Risk Factors
  • Spinal Fusion*
  • Survival Analysis
  • Tomography, X-Ray Computed
  • Treatment Outcome