Laparoscopic Anterior Spinal Fusion

In 1998, Dr. Vazquez and his orthopedic spine surgery colleague (Giri Gieesan, MD) introduced gasless retroperitoneal anterior lumbar inter fusion (ALIF) at Northwestern Memorial Hospital. This minimally invasive approach shares attributes seen with other minimally invasive procedures when compared to their open counterparts. A decrease in postoperative pain and length of stay are seen with the laparoscopic approach. The laparoscopic approach represents a further refinement in the technique of gaining access to the anterior spine. This new procedure combines relief of lower extremity pains due to disc disease, low operative blood loss, and rapid recuperation, with a shortened postoperative stay and less postoperative pain. Patients can return to light work situations in about six weeks time compared to three months for the conventional posterior approach.

Spinal fusion has been the mainstay of treatment for those patients with discogenic back and leg pain which fails standard therapy of microdiscectomy or laminectomy. The open posterior approach fails to consistently achieve pain relief, is associated with excessive blood loss, high complication rates, and prolonged recuperation. The anterior approach to spinal fusion is appealing because no bone or muacle destruction is required to gain access to the spine. General surgeons and orthopedic surgeons previously combined their expertise to perform open anterior spinal fusions. They now have joined forces to gain access to the spine using a laparoscopic approach.

Patients who have had back and lower extremity pain refractory to physical therapy, failed pain management with epidural steroids and microdiscectomy are potential candidates for laparoscopic anterior fusion procedures. Additionally, some patients who have had persistent lower extremity and back pain after aggressive measures for pain control such as facet rhizotomy, epidural steroids or morphine for pain control are suitable candidates for consideration for anterior spinal fusion.

Identification of the anatomical defect is made by plain radiograph and MRI. The provocative test of discography is used to identify and confirm the source of pain and also to determine the number of levels which need to be fused. Currently fusion is accomplished by insertion of PEEK (Sovereign™ ) implants filled with an FDA approved allograft material BMP (Bone Matrix Protein).

Balloon-assisted endoscopic retroperitoneal gasless (BERG) technique for anterior lumbar interbody fusion (ALIF). []

Surg Endosc.2003 Feb;17(2):268-72. Epub 2002 Oct 29.
Vazquez RM, Gireesan GT.

Department of Surgery, Northwestern University Medical School, 201 East Huron Street, Suite 11-250, Chicago, IL 60611, USA.

Content reviewed and updated on September 26, 2014.