New possibilities in L2-L5 lumbar arthrodesis using a lateral retroperitoneal approach assisted by laparoscopy: preliminary results.

Abstract

Four patients underwent lumbar interbody fusion, performed via a video-assisted retroperitoneal laparoscopic approach, complementary to posterior osteosynthesis at the L2-L3, L3-L4 and/or L4-L5 level. In three cases the interventions were for lumbar fractures, and in one case for microcristalline arthritis. After surgical training on human cadavers and several porcine operative sessions, retroperitoneal lateral approaches on the left side were performed by the authors without CO2 insufflation, assisted by videoscopy. The fusion process was monitored by fluoroscopy. It is possible to perform this technique cranially above L2 or caudally below L5. Minimal blood loss was observed. Average time for these interventions was 127 min. Interbody fusion was achieved in the first, second and fourth cases; the outcome in the third case at the final check-up, 6 months after operation, was uncertain. The first patient had a complication of ureteral wound, which was certainly caused by insufficient experience with the new technique. The authors hope to extend the application of this technique to other procedures as they become more experienced.