[The minimally invasive anterolateral approach to L2-L5]

Abstract

Objective: Minimally invasive anterolateral retroperitoneal approach to the lumbar spinal levels L2-L5.

Indications: Anterior interbody fusion for the treatment of degenerative disk disease (DDD), degenerative instability, isthmic and degenerative spondylolisthesis, tumors, degenerative scoliosis, fractures, spondylodiscitis, failed back syndrome (pseudarthrosis, post-diskectomy).

Contraindications: No absolute contraindications. Relative contraindications are previous surgeries via a sinistral retroperitoneal approach or a far lateral anatomy of the left iliac common vein covering the lateral annulus of the disk space L4/5.

Surgical technique: A small skin incision over the left abdominal wall is followed by a blunt muscle-splitting approach to the retroperitoneal space and the anterolateral circumference of the lumbar spine. A diskectomy, corporectomy and/or grafting (iliac crest or cage) may be performed for a solid ventral fusion.

Postoperative management: Early mobilization from the 1st postoperative day in all cases of combined ALIF (anterior lumbar interbody fusion)/ posterior instrumentation procedures. Thromboembolic prophylaxis with fractionated heparin. Light meals up until recovery of the first bowel movements. A brace is recommended depending on the type of the intervention for a duration of up to 12 weeks. No limitations for standing, walking or sitting in the immediate postoperative period.

Results: Minimally invasive anterior interbody fusion procedures with iliac crest bone graft were performed in 120 patients (average age 56.3 years, range 26-84 years) in combination with a dorsal instrumentation. 16 patients were treated with a double-level procedure. Duration of surgery ranged between 50 and 192 min (mean 102.2 min). The intraoperative blood loss was 67.3 cm(3). At the 6-month follow-up, the fusion rate was 95.6%. No vessel, bowel, kidney or spleen injuries were observed.