A prospective study of laparoscopic spinal fusion - Technique and operative complications

Objective The authors hypothesized that anterior transperitoneal laparoscopic interbody fusion was feasible and safe. Summary Background Data Low back pain associated with degenerative disc disease is optimally treated with distraction of the disc space and permanent fusion of the adjacent vertebral bodies. Exposure usually is obtained by a posterior muscle-splitting incision. Although the posterior approach is effective, the procedure results in significant debility secondary to the muscle splitting incision, a 4- to 6-day inpatient hospital stay, and the loss of employment for 3 to 6 months after the procedure. Methods Twenty consecutive patients with discogenic back pain were prospectively treated with laparoscopic anterior lumbar instrumentation and fusion. The anterior L5-S1 or L4-L5 disc spaces were exposed laparoscopically. Distraction of the disc space and fixation were achieved by insertion of a threaded titanium cage packed with cancellous bone. Results Three technical complications occurred all in the first four patients and required two conversions to open transperitoneal fusion. Hospital stay for the patients treated by laparoscopic instrumentation and fusion averaged 1.7 days. Twelve of 20 patients reported excellent pain relief and returned to work in 3 to 8 weeks. No motion was identified in the 16 patients who obtained flexion extension radiographs at 6 months. Conclusions Laparoscopic transperitoneal anterior lumbar instrumentation and fusion is safe, and the early results are encouraging.