A Prospective Comparison of Surgical Approach for Lateral Retroperitoneal L4-5 Fusion: Laparoscopic Versus Mini-ALIF / 대한척추외과학회지

ABSTRACT

STUDY DESIGN: We have analyzed the laparoscopic lateral retroperitoneal approach of the L4-5 interspace to the miniopen retroperitoneal approach for lateral lumbar interbody fusion. OBJECTIVES: To prospectively compare the laparoscopic lateral retroperitoneal approach of the L4-5 interspace to the miniopen retroperitoneal approach for lateral lumbar interbody fusion Summary of Background Data : The introduction of laparoscopic techniques in 1993 has stimulated a great deal of discussion regarding the risks and benefits of such minimally invasive approaches. In many centers the anterior endoscopic approach to L5-S1 has become routine. However exposure at L4-5 can be much more difficult. MATERIALS AND METHODS: From 1997 to 1999 thirty eight patients were entered into a prospective study. These patients were all undergoing anterior interbody fusion at the L4-5 level. The patients were divided into two groups for analysis. Group I patients underwent anterior interbody fusion utilizing threaded interbody devices placed via laparoscopic lateral retroperitoneal approach. Group II patients underwent anterior lumbar interbody fusion using threaded interbody devices placed via a miniopen retroperitoneal approach. RESULTS: In Group I, Operation time was 48 minutes longer than Group II (p=0.035) but there were no significant statistical differences in bleeding amount and hospitalization period. Parethesia and tingling sensation of thigh were developed in two cases of Group I patients, one case of Group II patients but they were gradually diminished. In Group I, only one cage was inserted in five cases of patients (28%) who had an inadequate exposure of L4-5 area. However, all of the patients in Group II (100%) had an adequate exposure of L4-5 area. CONCLUSION: The surgical results of laparoscopic technique was not superior to miniopen technique.