INSTRUMENTED LAPAROSCOPIC SPINAL-FUSION - PRELIMINARY-RESULTS

Study Design. Seventeen consecutive patients underwent laparoscopic instrumented interbody fusions using custom-designed delivery instrumentation and ''BAK'' fusion cages; both are manufactured by Spine-tech and the former was developed by the authors. The cases were performed at two spine centers under Food and Drug Administration investigational device evaluation clinical trials. Objectives, We expect this approach will maintain a high fusion rate with diminished hospitalization time, recovery time, patient discomfort, and expense. The rehabilitative aspects of the procedure are a great improvement over traditional fusion approaches. Summary and Background Data. Extraordinary advances in many endoscopic surgical fields have resulted in lowered morbidity, expense, and suffering associated with their open surgery counterparts. The authors have developed prototype of delivery instruments for the current laparoscopic fusion cage delivery system. Methods, The procedure is performed transperitoneally with carbon dioxide insufflation to enable video-assisted visualization through a 10-mm endoscope. Three 10-mm incisions and one 13- to 20-mm incision are required for one-level procedures. Two hollow titanium-threaded interbody implants are packed with autologous bone and inserted into the diseased interspace. Results, Seventeen patients, with an average follow-up period of 8 months and a range of 6-12 months, underwent the procedure. There were 14 single-level fusions and three two-level fusions, all involving L4-S1 levels. There were two cases that required conversion to open procedures without sequelae; two patients had remote donor site wound infections eradicated With incision and drainage and antibiotics, and one patient required subsequent posterior spinal decompression because of a displaced endplate fracture. Average hospital stay was an average of 2 days, excluding two patients with complications and very prolonged stay, Conclusions. Although this procedure is associated with a long learning curve, the technique, once mastered, is effective and advantageous over current approaches to lumbar fusion. Operative time and hospital stay are expected to decrease with future instrumentation development and surgeon experience.