Enhancing the Technical Pearls for L5-S1 Anterior Lumbar Interbody Fusion in Patients with Body Mass Index More Than 30: Clinical and Radiographic Outcomes at 1-Year Follow-Up

Background: Performing anterior lumbar interbody fusion (ALIF) in patients with a body mass index (BMI) >30 presents surgical challenges. To overcome those challenges, a modified procedure is described.

Methods: This study retrospectively reviewed patients with a BMI >30 who underwent the modified L5-S1 ALIF procedure from August 2017 to September 2023. Patient demographic and operative characteristics were collected. Clinical and radiographic outcomes were analyzed before surgery and at 1-year follow-up. An analysis was performed comparing patients with a BMI >30 who underwent the modified ALIF procedure versus the standard ALIF procedure.

Results: A total of 26 patients with BMI >30 were evaluated. Thirteen received treatment with the modified ALIF technique, and 13 received treatment with the standard ALIF technique. Operative time was significantly shorter in the modified ALIF technique cohort (P = 0.006). Preoperative and postoperative radiographic findings indicated significant differences in anterior disc height (P < 0.001), posterior disc height (P = 0.02), and L5-S1 segmental lordosis (P < 0.001) in patients undergoing the modified ALIF technique. There were no intraoperative complications. Postoperative visual analog scale for back pain, visual analog scale for leg pain, and Oswestry Disability Index scores significantly improved after surgery (P < 0.05) in both cohorts after 1 year. Complete interbody fusion was achieved according to computed tomography evaluation 1 year after surgery in more than 80% of cases.

Conclusions: ALIF surgery is a safe technique to address lumbar pathologies. This operative technique provides complimentary abdominal exposure data for access surgeons while performing ALIFs in patients with BMI >30. This technique could reduce operative time in such patients.