Comparison of the mini-open versus laparoscopic approach for anterior lumbar interbody fusion: a retrospective review.
OBJECTIVE
The anterior lumbar interbody fusion (ALIF) procedure has become an accepted fusion technique for treating patients with degenerative disorders of the lumbar spine. Many consider laparoscopic ALIF to be the least invasive approach. A modification of the open laparotomy--the "mini-open" approach--is an attractive alternative. In this retrospective review, a comparison of these two ALIF approaches is presented.


METHODS
We conducted a retrospective review of 98 patients who underwent ALIF procedures between 1996 and 2001 in which either a mini-open or a laparoscopic approach was used. Patient demographics, intraoperative parameters, length of hospitalization, and technique-related complications associated with the use of these two approaches were compared. The subset of patients who underwent L5-S1 ALIF procedures was analyzed separately. Statistical analysis was conducted with chi2 and Student's paired t tests.


RESULTS
Between 1996 and 2001, a total of 98 patients underwent ALIF. A laparoscopic approach was used in 47 of these patients, and the mini-open technique was used in the other 51 patients. Operative preparation and procedure time were longer with the use of a laparoscopic approach, and significantly greater during L5-S1 ALIF procedures (P < 0.05). A marginal but significant increase in length of stay was observed after mini-open ALIF procedures (P < 0.05). The immediate postoperative complication rate was greater after mini-open ALIF procedures, 17.6 versus 4.3% (P < 0.05); however, the rate of retrograde ejaculation was higher in the laparoscopic group, 45 versus 6% (P < 0.05).


CONCLUSIONS
Both the laparoscopic and mini-open techniques are effective approaches to use when performing ALIF procedures. On the basis of the data obtained in this retrospective review, the laparoscopic approach does not seem to have a definitive advantage over the mini-open exposure, particularly in an L5-S1 ALIF procedure. In our opinion, the mini-open approach possesses a number of theoretical advantages; however, the individual surgeon's preference ultimately is likely to be the dictating factor.
Department of Neurosurgery, Emory Clinic, Atlanta, Georgia 30322, USA.
Michael G
MG
Kaiser
Regis W
RW
Haid
Brian R
BR
Subach
Jay S
JS
Miller
C Dan
CD
Smith
Gerald E
GE
Rodts
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation*; D013167:Spondylitis, Ankylosing / Q000601:surgery*; D013168:Spondylolisthesis / Q000601:surgery*