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

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.