Abstract
Advances in laparoscopic technology have popularised minimally invasive approaches to the anterior lumbar spine. The use of the balloon assisted retroperitoneal approach however has not been widely described; moreover there has been no direct comparison between this mini anterior lumbar interbody fusion (ALIF) and the conventional open method in the literature.
Comparison of peri and intra-operative parameters between the mini-ALIF (using the balloon assisted dissector) and the open midline approach for single and double level anterior lumbar interbody fusions in order to assess the efficacy of this procedure.
An independent retrospective evaluation of 35 patients who underwent single or double level ALIF. A single surgeon at the University Hospital, Nottingham, performed the procedures during the period from 1997 to 2000. The patients were split between those undergoing a mini-ALIF (balloon assisted retroperitoneal dissection) and the conventional approach via a larger midline incision. The groups were matched for age, sex and number of levels. Data was collated from the medical notes with regards to intra-operative blood loss, operative time, intra-operative complications, Patient Controlled Analgesic (PCA) requirements, time to mobilisation and length of hospital stay.
A statistically significant reduction in operative time (mean 178mins Vs 255mins) and time to mobilisation (mean 2.2 days Vs 3.7days) was found for the single level mini-ALIF. No other significant difference was detected for the other criteria between the two groups for either single or double level procedures. Complications in the form of vascular injuries were almost equal in both groups.
Although operating time was significantly shortened using the balloon-assisted dissector other perioperative parameters were not. The question of cosmesis of the surgical scar was not explored in this study, this may have been more favorable in the mini-ALIF group but given the above results one must question whether the added expense of this innovative device is justified when there was no detected difference in all other measured criteria.
The abstracts were prepared by Wing Commander T. P. S. Bhullar. Correspondence should be addressed to him at the Ministry of Defence Hospital Unit, Edith Cavell Hospital, Bretton Gate, Peterborough PE3 9GZ.
