A Prospective Comparison of Surgical Approach for Anterior L4–L5 Fusion: Laparoscopic Versus Mini Anterior Lumbar Interbody Fusion

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Study Design.

A prospective comparison of 50 consecutive patients who underwent L4–L5 anterior lumbar interbody fusion (ALIF).


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.

Summary of Background Data.

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.


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.


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.


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.

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