Laparoscopy Assisted Miniopen Lateral Approach for Anterior Lumbar Interbody Fusion

Chong-Suh Lee; Sung-Soo Chung; Kwang-Hoon Chung

doi:10.4184/jkss.2002.9.4.341

Journal List > J Korean Soc Spine Surg > v.9(4) > 1036037

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Lee, Chung, and Chung: Laparoscopy Assisted Miniopen Lateral Approach for Anterior Lumbar Interbody Fusion

Original Article

Journal of Korean Spine Surg 2002;9(4):341-346.

Published online: 12 February 2002

DOI: https://doi.org/10.4184/jkss.2002.9.4.341

Laparoscopy Assisted Miniopen Lateral Approach for Anterior Lumbar Interbody Fusion

Chong-Suh Lee, M.D., Sung-Soo Chung, M.D., Kwang-Hoon Chung, M.D.

Department of Orthopedic Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul, Korea

Address reprint requests to Chong-Suh Lee, M.D. Department of Orthopaedic Surgery, Samsung Medical Center 50 Il Wong-dong, Gang nam-gu, Seoul 135-710, Korea Tel : 82-2-3410-3503, Fax : 82-2-3410-0061, E-mail : csl@smc.samsung.co.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study design

A new approach to anterior lumbar interbody fusion (A LIF).

Object ive

To investigate the advantages, technical pitfalls and complications of the laparoscopy assisted miniopen lateral approach.

Summary of literature review

Several kinds of miniopen approach or laparoscopy are now used for A LIF.

Materials and Methods

Thirty- five patients with various disease entities were included. Blood loss, operation time, incision size, postoperative time to mobilization, length of hospital stay, technical problems and complications were analyzed.

Results

Using this approach, T12 to L5 can be reached sub- diaphragmatically. Blood loss and operation time were 45.7 cc and 82.8 minutes for 1level, 103.2 cc and 107.6 minutes for two levels, 272.5 cc and 150 minutes for three levels, and 520 cc and 190 minutes for four- level- fusion, respectively, The incision sizes were on average 4.1cm for 1 level, 6.2 cm for 2 levels, 8.2 cm for 3 levels and 10.1 cm for four- level- fusion. Complications were retroperitoneal hematoma in 2 cases, pneumonia in 1 case and transient lumbosacral plexus palsy in 3 cases.

Conclusion

The laparoscopy assisted miniopen lateral approach is an advantageous approach with a very short learning curve. However, special attention is required if complications such as transient lumbosacral plexus palsy are to be avoided.

Keywords: Lumbar spine, Laparoscopy, Miniopen lateral approach, Interbody fusion

REFERENCES

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Fig. 1.

Incision line between the center of upper vertebral body and center of lower vertebral body under fluoroscopic guided

Fig. 2.

Abdominopelvic CT demonstrating the planes of miniopen lateral approach

Fig. 3.

Malpositioning of cage due to obstruction of high iliac crest

Table 1.

Fusion levels and Number of cases

	Fusion level	Number
	L1-2	3
1 Level (15 cases)	L2-3	3
	L3-4	2
	L4-5	7
	T12-L2	3
2 Levels (13 cases)	L1-3	4
	L2-4	2
	L3-5	3
	L1-2, L4-5	1
3 Levels (5 cases)	T12-L3	1
	L1-4	2
	L2-5	2
4 Levels (2 cases)	L1-5	2

Table 2.

Blood loss & OP time (In simple ALIF)

	EBL^∗ (cc)	OP time (min)
1 level (9)^†	45.7	82.8
2 levels (5)	103.2	107.6
3 levels (4)	272.5	150
4 levels (1)	520	190

^∗ : estimated blood loss ()

^† : number of cases

Table 3.

Blood loss & OP time (Additional debridement and corpectomy)

	EBL^∗ (cc)	OP time (min)
1 level (6)^†	385	108
2 levels (8)	470.5	122.6
3 levels (1)	420	240
4 levels (1)	1300	230

^∗ : estimated blood loss ()

^† : number of cases

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