The Minimally Invasive Anterolateral Approach to L2-L5

Objective Minimally invasive anterolateral retroperitoneal approach to the lumbar spinal levels L2-L5. Indications Anterior interbody fusion for the treatment of degenerative disk disease (DDD), degenerative instability, isthmic and degenerative spondylolisthesis, tumors, degenerative scoliosis, fractures, spondylodiscitis, failed back syndrome (pseudarthrosis, post-diskectomy). Contraindications No absolute contraindications. Relative contraindications are previous surgeries via a sinistral retroperitoneal approach or a far lateral anatomy of the left iliac common vein covering the lateral annulus of the disk space L4/5. Surgical Technique A small skin incision over the left abdominal wall is followed by a blunt muscle-splitting approach to the retroperitoneal space and the anterolateral circumference of the lumbar spine. A diskectomy,corporectomy, and/or grafting (iliac crest or cage) may be performed for a solid ventral fusion. Postoperative Management Early mobilization from the 1st postoperative day in all cases of combined ALIF (anterior lumbar interbody fusion)/posterior instrumentation procedures. Thromboembolic prophylaxis with fractionated heparin. Light meals up until recovery of the first bowel movements. A brace is recommended depending on the type of the intervention for a duration of up to 12 weeks. No limitations for standing, walking or sitting in the immediate postoperative period. Results Minimally invasive anterior interbody fusion procedures with iliac crest bone graft were performed in 120 patients (average age 56.3 years, range 26-84 years) in combination with a dorsal instrumentation. 16 patients were treated with a double-level procedure. Duration of surgery ranged between 50 and 192 min (mean 102.2 min). The intraoperative blood loss was 67.3 cm(3). At the 6-month follow-up, the fusion rate was 95.6%. No vessel, bowel, kidney or spleen injuries were observed.