Laparoscopic Anterior Lumbar Interbody Fusion: A Review of Outcome Studies

Abstract

Laparoscopic anterior lumbar interbody fusion (LALIF) was first reported in 1995. It was expected to reduce the morbidity of an open ALIF, while maintaining its advantages. About a decade after its debut, the feasibility and short-term efficacy of the LALIF has been recognized. Currently, other minimally-invasive surgical options have been made available for the treatment of lumbar degenerative disc disease, and thus the role of LALIF has not been established in view of these other methods. The authors aim to clarify this, by conducting a review of the literature particularly on the outcome studies of LALIF. Several comparative studies showed that at the L5-S1 disc level, there was no marked difference between LALIF and the open or mini-open ALIF in terms of short-term efficacy, i. e., operative time, blood loss, and length of hospital stay. With regard to the complication rate, however, there was a higher incidence of retrograde ejaculation in LALIF. At the L4-L5 and L4-L5/L5-S1 disc levels, the complication rate and conversion rate to open surgery was high in LALIF, and many authors were not impressed with the LALIF at these levels. Several case series showed that the LALIF yielded excellent perioperative outcomes in the hands of experienced endoscopic spine surgeons at both the L5-S1 and L4-L5 disc levels. No conclusion regarding either the superiority or inferiority of LALIF to the open or mini-open ALIF can be drawn, because of the lack of data with a high-level of evidence. It cannot be denied, however, that some spine surgeons are abandoning this procedure and switching to the mini-open ALIF. Treatment of lumbar degenerative disc disease itself has been changing rapidly, as represented by the recent emergence of the lumbar artificial disc, and the future role of LALIF remains to be followed closely.

Anterior lumbar interbody fusion - endoscopic - laparoscopic - outcome

References

• 1 Foley K T, Holly L T, Schwender J D. Minimally invasive lumbar fusion.  Spine. 2003;  28 (15 Suppl) S26-S35
• 2 Kim D H, Jaikumar S, Kam A C. Minimally invasive spine instrumentation.  Neurosurgery. 2002;  51 (5 Suppl) S15-S25
• 3 Katkhouda N, Campos G M, Mavor E, Mason R J, Hume M, Ting A. Is laparoscopic approach to lumbar spine fusion worthwhile?.  Am J Surg. 1999;  178 458-461
• 4 Liu J C, Ondra S L, Angelos P, Ganju A, Landers M L. Is laparoscopic anterior lumbar interbody fusion a useful minimally invasive procedure?.  Neurosurgery. 2002;  51 (5 Suppl) S155-S158
• 5 Mathews H H, Evans M T, Molligan H J, Long B H. Laparoscopic discectomy with anterior lumbar interbody fusion. A preliminary review.  Spine. 1995;  20 1797-1802
• 6 Zucherman J F, Zdeblick T A, Bailey S A, Mahvi D, Hsu K Y, Kohrs D. Instrumented laparoscopic spinal fusion. Preliminary results.  Spine. 1995;  20 2029-2035
• 7 Geerdes B P, Geukers C W, Erp W F van. Laparoscopic spinal fusion of L4-L5 and L5-S1.  Surg Endosc. 2001;  15 1308-1312
• 8 Inamasu J, Kim D H, Logan L. Three-dimensional computed tomography anatomy of the abdominal great vessels pertinent to L4-L5 anterior lumbar interbody fusion. Minim Invas Neurosurg 2005 48: 127-131
• 9 Blumenthal S L, Ohnmeiss D D. Intervertebral cages for degenerative spinal diseases.  Spine J. 2003;  3 301-309
• 10 Mulholland R C. Cages: outcome and complications.  Eur Spine J. 2000;  9 (Suppl 1) S110-S113
• 11 Chung S K, Lee S H, Lim S R, Kim D Y, Jang J S, Nam K S, Lee H Y. Comparative study of laparoscopic L5-S1 fusion versus open mini-ALIF, with a minimum 2-year follow-up.  Eur Spine J. 2003;  12 613-617
• 12 Cowles R A, Taheri P A, Sweeney J F, Graziano G P. Efficacy of the laparoscopic approach for anterior lumbar spinal fusion.  Surgery. 2000;  128 589-596
• 13 Hawasli A, Thusay M, Elskens D P, Gehring R L, Sidhu K S, Moreale V M, Lloyd L L. Laparoscopic anterior lumbar fusion.  J Laparoendosc Adv Surg Tech A. 2000;  10 21-25
• 14 Hannon J K, Faircloth W B, Lane D R, Ronderos J F, Snow L L, Weinstein L S, West J L 3rd. Comparison of insufflation vs. retractional technique for laparoscopic-assisted intervertebral fusion of the lumbar spine.  Surg Endosc. 2000;  14 300-304
• 15 Henry L G, Cattey R P, Stoll J E, Robbins S. Laparoscopically assisted spinal surgery.  JSLS. 1997;  1 341-344
• 16 Kaiser M G, Haid Jr  RW, Subach B R, Miller J S, Smith C D, Rodts Jr  GE. Comparison of the mini-open versus laparoscopic approach for anterior lumbar interbody fusion: a retrospective review.  Neurosurgery. 2002;  51 97-105
• 17 Kleeman T J, Ahn M U, Clutterbuck W B, Campbell C J, Talbot-Kleeman A. Laparoscopic anterior lumbar interbody fusion at L4-L5: an anatomic evaluation and approach classification.  Spine. 2002;  27 1390-1395
• 18 Kleeman T J, Ahn O M, Talbot-Kleeman A. Laparoscopic anterior lumbar interbody fusion with rhBMP-2: a prospective study of clinical and radiographic outcomes.  Spine. 2001;  26 2751-2756
• 19 Lieberman I H, Willsher P C, Litwin D E, Salo P T, Kraetschmer B G. Transperitoneal laparoscopic exposure for lumbar interbody fusion.  Spine. 2000;  25 509-515
• 20 Mahvi D, Zdeblick T A. A prospective study of laparoscopic spinal fusion: technique and operative complications.  Ann Surg. 1996;  224 85-90
• 21 Olsen D, McCord D, Law M. Laparoscopic discectomy with anterior interbody fusion of L5-S1.  Surg Endosc. 1996;  10 1158-1163
• 22 Pellise F, Puig O, Rivas A, Bago J, Villanueva C. Low fusion rate after L5-S1 laparoscopic anterior lumbar interbody fusion using twin stand-alone carbon fiber cages.  Spine. 2002;  27 1665-1669
• 23 Regan J J, McAfee P C, Guyer R D, Aronoff R J. Laparoscopic fusion of the lumbar spine in a multicenter series of the first 34 consecutive patients.  Surg Laparosc Endosc. 1996;  6 459-468
• 24 Regan J J, Aronoff R J, Ohnmeiss D D, Sengupta D K. Laparoscopic approach to L4-L5 for interbody fusion using BAK cages: experience in the first 58 cases.  Spine. 1999;  24 2171-2174
• 25 Regan J J, Yuan H, McAfee P C. Laparoscopic fusion of the lumbar spine: minimally invasive spine surgery. A prospective multicenter study evaluating open and laparoscopic lumbar fusion.  Spine. 1999;  24 402-411
• 26 Rodriguez H E, Connolly M M, Dracopoulos H, Geisler F H, Podbielski F J. Anterior access to the lumbar spine: laparoscopic versus open.  Am Surg. 2002;  68 978-982
• 27 Zdeblick T A, David S M. A prospective comparison of surgical approach for anterior L4-L5 fusion: laparoscopic versus mini anterior lumbar interbody fusion.  Spine. 2000;  25 2682-2687
• 28 Cook D J, Guyatt G H, Laupaucis A, Sacket D L. Rule of evidence and clinical recommendations on the use of antithrombotic agents.  Chest. 1992;  102 305-311
• 29 Liu J K, Nwagwu C, Pikus H J, Couldwell W T. Laparoscopic anterior lumbar interbody fusion precipitating pituitary apoplexy.  Acta Neurochir (Wien). 2001;  143 303-307
• 30 Escobar E, Transfeldt E, Garvey T, Ogilvie J, Graber J, Schultz L. Video-assisted versus open anterior lumbar spine fusion surgery: a comparison of four techniques and complications in 135 patients.  Spine. 2003;  28 729-732
• 31 Cammisa Jr  FP, Girardi F P, Antonacci A, Sandhu H S, Parvataneni H K. Laparoscopic transperitoneal anterior lumbar interbody fusion with cylindrical threaded cortical allograft bone dowels.  Orthopedics. 2001;  24 235-239
• 32 Heim S E, Altimari A. Laparoscopic approaches to fusion of the lumbosacral spine: latest techniques.  Orthop Clin North Am. 2002;  33 413-420
• 33 Heniford B T, Matthews B D, Lieberman I H. Laparoscopic lumbar interbody spinal fusion.  Surg Clin North Am. 2000;  80 1487-1500
• 34 Staelin S T, Zdeblick T A, Mahvi D M. Laparoscopic lumbar spinal fusion: the role of the general surgeon.  J Laparoendosc Adv Surg Tech A. 2000;  10 297-304
• 35 Sasso R C, Burkus J K, LeHuec J C. Retrograde ejaculation after anterior lumbar interbody fusion: transperitoneal versus retroperitoneal approach.  Spine. 2003;  28 1023-1026
• 36 Mayer H M. The ALIF concept.  Eur Spine J. 2000;  9 Suppl 1 S35-S43
• 37 Zigler J E, Anderson P A, Boden S D, Bridwell K H, Vaccaro A R. What's new in spine surgery.  J Bone Joint Surg [Am]. 2003;  85 1626-1636
• 38 Bhatnagar M K, Mathur S K, Mess C F. Laparoscopic spinal fusion.  Md Med J. 1999;  48 161-164
• 39 Brody F, Rosen M, Tarnoff M, Lieberman I. Laparoscopic lateral L4-L5 disc exposure.  Surg Endosc. 2002;  16 650-653
• 40 Nakamura H, Ishikawa T, Konishi S, Seki M, Yamano Y. Psoas strapping technique: a new technique for laparoscopic anterior lumbar interbody fusion.  J Am Coll Surg. 2000;  191 686-688
• 41 Thalgott J S, Chin A K, Ameriks J A, Jordan F T, Giuffre J M, Fritts K, Timlin M. Minimally invasive 360 degrees instrumented lumbar fusion.  Eur Spine J. 2000;  9 (Suppl 1) S51-S56
• 42 Thalgott J S, Chin A K, Ameriks J A, Jordan F T, Daubs M D, Giuffre J M, Fritts K, Timlin M. Gasless endoscopic anterior lumbar interbody fusion utilizing the B.E.R.G. approach.  Surg Endosc. 2000;  14 546-552
• 43 Vazquez R M, Gireesan G T. Balloon-assisted endoscopic retroperitoneal gasless (BERG) technique for anterior lumbar interbody fusion (ALIF).  Surg Endosc. 2003;  17 268-272