Abstract
Introduction: Anterior lumbar interbody fusion has become a frequently utilised procedure. The trend has been towards less invasive techniques including laparascopic and mini-open techniques. This report examines the results of one procedure and suggests appropriate tools to decrease the learning curve.
Methods: Twenty-two patients with a mean age of 41 (17–78) underwent mini-open ALIF with threaded cortical bone dowels. The same senior surgeon performed all procedures (RFD). Indication for the procedure was discogenic pain verified by concordant discography after a failure of a minimum of six months non-operative treatment. Patients were followed at standard intervals. Complications as well as the evolution of surgical technique were recorded prospectively for all patients.
Results: Twenty-one of 22 patients had the successful implantation of two dowels at each level. Intraoperative fluoroscopy and auditory EMG monitoring was used in all cases. Thirty-two levels were fused from L2–S1 (Average =1.39 levels). Average length of stay was 2.96 days (1–14). Follow-up averaged 24.93 months (2–36). Fusion was achieved in 15/16(93%) of the one level cases but only 3/6 (50%) of the two level cases. Posterior reoperation with posterolateral fusion and pedicle screws was performed in 2/3 of these patients. Use of a dedicated pin-based anterior lumbar retractor enabled a 45% reduction in incision length with a 40% decrease in operative time. Complications included: massive bleeding (1), post-operative dysesthetic leg pain (2), postoperative kyphosis (2), lateral graft displacement (1).
Discussion and conclusion: ALIF remains a formidable surgical procedure. Precise identification of the midline and use of fluoroscopy assures good placement of the devices. Preoperative osteopenia should be recognised and treated with posterior stabilisation. Posterior stenosis should be a relative contraindication. We have abandoned multilevel standalone procedures given the poor fusion rate. A pin-based retractor allows a smaller incision with less operative time. Attention to myriad technical details remains paramount.
The abstracts were prepared by Dr Robert J. Moore. Correspondence should be addressed to him at The Spine Society of Australia, Institute of Medical and Veterinary Science, The Adelaide Centre for Spinal Research, Frome Road, Adelaide, South Australia 5000
