J Korean Soc Spine Surg.  2001 Dec;8(4):534-540.

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

• Kim SW
• Kang KP
• Chung YK

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.

Keyword

Surgical approach; AIF; L4-5

MeSH Terms

Hemorrhage
Hospitalization
Humans
Prospective Studies*
Risk Assessment
Sensation
Thigh

Figure

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  Fig. 1. Plain anteroposterior radiograph showing only one cage insertion due to inappropriate exposure of operation field

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  Fig. 2. Plain lateral radiograph showing only one cage insertion due to inappropriate exposure of operation field

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