Mini-invasive extraperitoneal approach for anterior lumbar surgery

Abstract

To study a mini-invasive extraperitoneal approach to lumbar spine and discuss its exposure technique, complications and management. Anterior lumbar surgery was performed in 52 patients via the mini-invasive anterior extraperitoneal approach. Diagnoses included lumbar degenerative instability (n=23), discogenic lumbar pain (n=25), lumbosacral congenital deformity (n=2) and revision after posterior laminectomy & discectomy (n=2). The patients underwent anterior lumbar interbody fusion (n=32) and total disk replacement (n=20). The operated disks included L(4-5) and L5-S1. There were single level (n=47) and double level (n=5). Operation time, blood loss, perioperative complications, postoperative bed-leaving time, incision length, pain of abdomen incision and postoperative hospitalization duration were recorded in details. All cases were exposed clearly and no one needed to prolong incision or change operation for an insufficient exposure. Average operation time was 85 min, average blood loss 155 ml, average postoperative bed-leaving time 3 days and average incision length 6.5 cm. All cases felt very little pain of abdominal incision and postoperative hospitalization duration was 7-10 days. Perioperative complications included vena cava tear (n=1), peritoneum tear (n=2), postoperative abdominal distention (n=3) and postoperative fever (n=5). No retrograde ejaculation was found in all male cases. The technique of mini-invasive extraperitoneal approach to anterior lumbar has such multiple advantages as fewer complications, less trauma, excellent exposure to anterior vertebrae and disk and without destruction of posterior spinal component