Laparoscopic discectomy with anterior lumbar interbody fusion. A preliminary review.

Abstract

Patients presenting with L5-S1 anterior column disease with or without herniation into the spinal canal but without stenosis underwent magnetic resonance imaging screening before surgery to determine surgical suitability for laparoscopic anterior lumbar interbody fusion relative to the aortic bifurcation and approach to the disc space. To analyze and evaluate the laparoscopic approach, technique, and benefit of anterior lumbar discectomy and interbody fusion by distraction and compression-loading of autograft only as compared with cage-spacer-enhanced autograft fusion. Advancement in minimally invasive spine surgery techniques has provided options with less morbidity for posterior lumbar procedures. General surgical advancements in laparoscopy and advantages of traditional anterior lumbar interbody fusion, including restoration of disc height and exposure for safe nerve decompression, provided a basis for an integrated procedure that would address anterior column abnormality with low surgical morbidity. Five patients underwent technically successful laparoscopic anterior lumbar interbody fusion with approach to the disc space by an experienced laparoscopic general surgeon. A sixth patient in the study group was unable to undergo laparoscopic fusion because of an iliac vein tear during the surgical approach. After the approach, a spine surgeon followed with complete manual discectomy and interbody autogenous fusion laparoscopically. Two to three Cloward-type dowels were obtained by separate incision from the anterior iliac crest. All patients by 6-month follow-up examination were clinically fused with no motion on flexion-extension radiographs. One patient had slight anterior retropulsion of one dowel without the necessity of reoperation. Laparoscopic L5-S1 anterior lumbar interbody arthrodesis may represent a viable option for patients with abnormality, including anterior column and degenerative disc disease.