Minimally Invasive 360 Degree Instrumented Lumbar Fusion

We report on a gasless, retroperitoneal approach to lumbar interbody fusion combined with minimally invasive, posterior translaminar fixation and posterolateral fusion.

Materials & Methods:

Forty–six (46) patients, 21 female and 25 male, underwent successful anteroposterior lumbar fusion. All patients underwent anterior surgery through a gasless endoscopic, retroperitoneal approach. Posteriorly, patients were implanted with translaminar fixation at each level and were fused posterolaterally with autograph through a small, 2.5–5 cm incision. All patients underwent both procedures on the same day. There were 30 single–level and 16 double–level fusions.

Results:

Follow–up in this series averages 33 months with a range of 24–43 months. Mean hospital stay was 2.02 days. Mean combined blood loss was 255 cc. Mean combined operative time was 183 minutes for single–level and 215 minutes for double–level fusions. Hardware was removed in 3 patients resulting in 1 solid fusion and two pseudarthroses. All other posterior hardware remains intact. There were no evidence of implant or disc space collapse anteriorly and 1 halo >25% yielding an overall fusion rate of 93%. Mean pain levels decreased 56% with 76% (34/46) of patients reporting good or excellent pain relief. In patients working prior to surgery, the return rate was 47% at an average of 5 months postop.

Conclusions:

From these results, we conclude that minimally invasive 360º instrumented lumbar fusion provides a high rate of arthrodesis and excellent clinical results. It also provides short hospital stays, relatively short operative times, accelerated rehabilitation, and a quick return to the work force.