Minimally Invasive Anterior Lumbar Interbody Fusion.

Bak, Koang Hum; Kim, Young Soo; Kim, Jae Min; Kim, Choong Hyun; Koh, Yong; Oh, Seong Hoon; Oh, Suck Jun; Kim, Kwang Myung; Kim, Nam Kyu

Original Article

Journal of Korean Neurosurgical Society 1998;27(6): 792-799.

Koang Hum Bak, Young Soo Kim, Jae Min Kim, Choong Hyun Kim, Yong Koh, Seong Hoon Oh, Suck Jun Oh, Kwang Myung Kim, Nam Kyu Kim

Department of Neurosurgery, School of Medicine, Hanyang University, Seoul, Korea.

ABSTRACT

A new technique and clinical experience of minimally invasive anterior lumbar interbody fusion(mini-ALIF) are reported. Despite its biomechanical advantages and high fusion rate, conventional ALIF needs a long skin incision and extensive dissection. Endoscopic approaches for ALIF seem to be associated with considerable technical difficulties, long operation time, and high complication rate even in collaboration with a laparoscopic surgeon. Mini-ALIF involves a standardized minimally invasive microsurgical retroperitoneal approach for L2-3 to L4-5, and transperitoneal approach for L5-S1. Mini-ALIF can be done through minimal skin incision(4-5cm) and blunt muscle dissection without abdominal muscle cutting. Between December 1995 and March 1997, 12 cases with various lumbar diseases underwent mini-ALIFs. The surgical indications were postoperative pseudarthrosis in 5 cases, degenerative spondylolisthesis in 4 cases, and iatrogenic postoperative instability in 3 cases. Seventy-five percent of patients including reoperation cases showed good outcome and high fusion rate on more than 6 months follow-up. There was no permanent technique-related complication. Mini-ALIF provided sufficient operation space for lumbar interbody fusion. Consequently, authors could reduce operation time, bleeding, and postoperative morbidity of ALIF.

Key Words: Minimally invasive surgery; Anterior lumbar interbody fusion; Spinal fusion; Lumbar spine; Microsurgery