Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P134. Application of laparoscopic lumbar discectomy and anterior lumbar interbody fusion: at least six years of follow-up

Abstract

BACKGROUND CONTEXT Symptomatic degenerative disc disease is the major cause of low back pain with lumbar segmental instability. Anterior discectomy and interbody fusion has increased in popularity as an alternative treatment for lumbar disc herniation. However, the traditional approach to spinal surgery carries the risk of catastrophic bleeding from injury to major vessels, as well as iatrogenic injury to the viscera and associated structures. Therefore, laparoscopic lumbar discectomy and interbody fusion may represent a useful alternative. PURPOSE The current study aimed to assess the mid-term safety and efficacy of lumbar discectomy and anterior lumbar interbody fusion (ALIF) using a laparoscopic technique for lumbar disc herniation. STUDY DESIGN/SETTING This prospective observational study included 32 patients who were diagnosed with symptomatic degenerative disc disease treated via lumbar discectomy and ALIF with a laparoscopic technique. PATIENT SAMPLE Thirty-two patients (12 males and 20 females) who were diagnosed with symptomatic degenerative disc disease were included in this study. Four cases involved the L4/5 level, and 28 cases involved the L5/S1 level. All patients were ineffective after at least 6 months of conservative treatments; all patients were informed of the surgery before the operation and provided consent. OUTCOME MEASURES All patients were followed up for more than 6years, X-ray and CT were reviewed regularly to evaluate the height change of intervertebral space and the fusion of bone graft. The clinical effects of preoperative, postoperative and follow-up were evaluated by VAS score, and the complications of laparoscopic surgery were observed. METHODS Thirty-two patients (12 males and 20 females) who were diagnosed with symptomatic degenerative disc disease were included in this study. Four cases involved the L4/5 level, and 28 cases involved the L5/S1 level. All patients were ineffective after at least 6 months of conservative treatments; all patients were informed of the surgery before the operation and provided consent. Three-dimensional computed tomographic angiography (3D-CTA) of the iliac great blood vessels was completed before the surgery. All surgical procedures were performed under a laparoscope. All patients were followed up for more than 6years, X-ray and CT were reviewed regularly to evaluate the height change of intervertebral space and the fusion of bone graft. The clinical effects of preoperative, postoperative and follow-up were evaluated by VAS score, and the complications of laparoscopic surgery were observed. RESULTS All surgeries were successfully completed. All cases were followed up for more than 6years, the average follow-up time was 9years (range 6–12 years). All cases got bone fusion, the average time was 4.5 months (range 3–12 months). The mean VAS were decreased postoperatively, The VAS score of low back pain for preoperative, postoperative (1 week) and final follow-up was 5.8±1.1, 1.8±0.7, 0.9±0.7, the change were statistically significant (p .05). The outcome indicated that there was no mobilization, displacement or intestinal adhesion in all patients in the mid-term follow-up. CONCLUSIONS Laparoscopic lumbar discectomy and ALIF is an effective treatment for severe degenerative lumbosacral diseases