Retroperitoneal Approach for Anterior Lumbar Interbody Fusion and Combined Anteroposterior Lumbar Fusion

Daniel H. Kim, MD
Gordon Sakamoto, BS
Steve Paragioudakis, MD
Glenn O'Sullivan, MD
Eugene Carragee, MD (Stanford, CA)

A minimum 2–year follow–up of 92 patients that underwent anterior lumbar interbody fusion (ALIF) alone or combined ALIF with Posterior lumbar instrumentation with fusion during 1991–1997 was reviewed.

There were 28 ALIF alone (30.4%), 38 ALIF with posterior instrumentation on the same day (41.3%), and 26 staged procedure with posterior instrumentation either preceding or following an ALIF (28.3%). 38 women and 54 men whose mean age was 46 years (range 28–74). 43 patients (47%) had previous spinal surgeries.

Indications for surgeries included 29 symptomatic degenerated disc disease (31.5%), 23 spondylolisthesis (25%), 17 pseudoarthrosis (18.5%), 17 post–surgical segmental instabilities (18.5%), 3 burst fractures (3.3%), 2 malignancies (2.2%) and 1 infection (1.1 %). Single level fusion in 42 patients (45.7%), two level in 42 patients (45.7%), and three level in 8 patients (8.6%) were studied.

Of the 150 total levels of ALIF studied, 54 used a femoral ring allograft, 77 used autologous iliac crest and 21 used a BAK or Harm's cage. The average hospital stay for ALIF alone, combined anteroposterior lumbar fusion on same day, and staged procedures were 5.2, 8.2 and 12.2 days respectively.

Solid fusion was seen on x–ray studies with flexion/extension views in 78 of 92 cases (18.5%) which included 5 prolonged urinary retention and/or ileus, 3 wound infections, 2 iliac vessel injuries, 2 dural tears, 2 myocardiac infarction, 1 cage shift, 1 lower limb sympathecteomy, and 1 retrograde ejaculation.