A Prospective Comparison of Surgical Approach for Anterior L4–L5 Fusion

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Abstract
A prospective comparison of 50 consecutive patients who underwent L4-L5 anterior lumbar interbody fusion (ALIF). To compare surgical time, blood loss, time in hospital, complications and adequacy of exposure between laparoscopic and mini-ALIF surgical approaches for L4-L5 anterior spinal fusion. Advances in minimally invasive laparoscopic techniques have resulted in many centers adopting the endoscopic approach to L5-S1 as routine. However, the endoscopic approach to L4-L5 can be much more difficult. A direct comparison of open and laparoscopic techniques of exposure has not been reported. From 1995 through 1998, data were prospectively collected on a series of 50 consecutive patients who underwent L4-L5 anterior interbody fusion with a threaded device, by either a laparoscopic or an open mini-ALIF approach. Twenty-five patients underwent a laparoscopic procedure and 25 an open mini-ALIF approach. For single-level L4-L5 fusions, there was no statistical difference in operating time, blood loss, or length of hospital stay between laparoscopic or mini-ALIF groups. For two-level procedures, only the operative time differed, with laparoscopic procedures taking 25 minutes longer (P = 0.035). The rate of complications was significantly higher in the laparoscopic group (20% vs. 4%). In the laparoscopic group, 16% of patients had inadequate exposure, with the result that only a single cage was placed. In the open mini-ALIF group, two cages were placed in all cases. There does not appear to be a significant advantage at the L4-L5 level of the transperitoneal laparoscopic surgical approach when compared with an open mini-ALIF retroperitoneal technique.