title: A prospective comparison of surgical approach for anterior L4-L5 fusion: laparoscopic versus mini anterior lumbar interbody fusion.
abstract: METHODS
  A prospective comparison of 50 consecutive patients who underwent L4-L5 anterior lumbar interbody fusion (ALIF).
  
  
  OBJECTIVE
  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.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic Surgery, University of Wisconsin Clinical Science Center, Madison, Wisconsin 53792-3236, USA. zdeblick@surgery.wisc.edu
authors.forename: T A
authors.initials: TA
authors.lastname: Zdeblick
authors.forename: S M
authors.initials: SM
authors.lastname: David
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007084:Iliac Vein / Q000293:injuries / Q000601:surgery; D016268:Internal Fixators / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data; D007403:Intervertebral Disc / Q000033:anatomy & histology / Q000098:blood supply / Q000601:surgery; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012187:Retroperitoneal Space / Q000293:injuries / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000293:injuries / Q000601:surgery