Patrick P. Flannagan, M.D. Sheri A. Mancini. M.D. Donald M. Whiting, M.D. Alexander Kandabarow, M.D. Nancy J. Hogle, B.S.N. Dennis L Fowler, M.D. West Penn Allegheny Health System Allegheny General Hospital Pittsburgh, PA

The use of the laparoscopic approach to the lumbar spine is becoming increasingly popular due to decreased blood loss and post-operative discomfort. Here we review our experience with the laparoscopic exposure and anterior interbody fusion of the lumbar spine for degenerative disc disease.

Fifty-eight patients underwent anterior laparoscopic interbody fusion (ALIF) between Feb.,1998 and Aug.,1999. Twenty-six patients were male and 31 were female. An anterior transabdominal laparoscopic approach was used in all cases. All patients had fusion of L4-5, L5-S1, or both. Exposure of the disc spaces was performed by the laparoscopic surgeon, while placement of the cages was performed by the neurological or orthopedic surgeon. Average age was 42.7 years (25-61). Fifteen patients had L4-5 fusion, 34 had L5-SI fusion, and 9 had fusion at both levels. All but 8 patients had two cages placed at the fused level. Two patients had L5-S1 vertebral anatomy that would only permit one cage. All others had one cage placed due to limitations of exposure by the venous anatomy. Mean operative time was 3.12 hours; 2.88 hours for one level, and 4.82 hours for two levels. Average blood loss was less than 100cc (25-400). No fusion was abandoned due to exposure. No procedures were converted to open technique. Mean length of stay was 2.3 days (1-6).

Postoperative morbidity was 13.7% (8/58). One patient required blood transfusion. Three required extended admission (greater than 2 days) secondary to abdominal complaints (pain, ileus, etc.). One patient had EKG changes without an infarct. One patient had retrograde ejaculation which resolved within 6 weeks. One patient was re-admitted for left lower extremity edema. Evaluation revealed no evidence of deep venous thrombosis or vascular injury. One patient required re-operation for lateral migration of an L4-5 cage. No patient suffered bowel or vascular injury.

Laparoscopy is a safe, effective means of approaching the lumbar spine for anterior interbody fusion with low morbidity and a shortened recovery time.



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