Minimal Invasive Retroperitoneal Anterior Lumbar Interbody Fusion with Video-Assistance

ABSTRACT

INTRODUCTION: Anterior lumbar interbody fusion with video-assistance has become an increasing popular technique to stabilize the anterior vertebral column disease. A minimally invasive technique with reduced soft tissue dissection allows low morbidity and has cosmetic and functional advantages. METHOD: Fifty patients with chronic degenerative lumbar instability [degenerative disc disease(14), degenerative spondylolisthesis(14), Grade I lytic spondylolisthesis(9) and failed back syndrome(13)] who did not respond to conservative treatment for 6 months underwent minimal invasive retroperitoneal ALIF with video-assistance from Oct. 1996 to Sep. 1997. Access to lumbar disc was achieved through retroperitoneal space with a small vertical 4 to 5 cm incision on the midline after retroperitoneal endoscopic ballooning. After performing complete discectomy under guidance of endoscopic viewing and restoring the narrowed disc height, we stabilized the spine with carbon interbody fusion cages filled with allograft bone. RESULTS: Postoperatively the patients were usually allowed to ambulate on the following day and were discharged within 4 days. There were three major complications; one ureter injury, one retroperitoneal hematoma and one osteomyelitis. With an average 10 months follow up, 42 out of 50 patients(84%) have shown relief of symptomatic back pain. And 27 out of 28 patients with degenerative disc disease and degenerative spondylolisthesis(96%) had successful results. CONCLUSIONS: Minimal invasive retroperitoneal ALIF with video-assistance offers an attractive method to significant decreased postoperative pain and hospital stay compared with conventional anterior approaches. The patients with degenerative disc disease or degenerative spondylolisthesis were more likely to have a successful outcome than those with Grade I lytic spondylolisthesis or failed back syndrome(p=0.02).