European Spine Journal

, Volume 13, Issue 5, pp 425–431 | Cite as

Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion

  • V. SaraphEmail author
  • C. Lerch
  • N. Walochnik
  • C. M. Bach
  • M. Krismer
  • C. Wimmer
Original Article


The purpose of the study was to compare conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion (ALIF). Fifty-six consecutive patients with spondylolisthesis, lumbar instability, or failed back syndrome were treated with ALIF between 1991 and 2001. The patients were retrospectively evaluated and divided in two groups: Group 1, consisting 33 patients, was treated with ALIF using the conventional retroperitoneal approach, and Group 2, consisting of 23 patients, was operated with the minimally invasive muscle-splitting approach for ALIF. The groups were comparable as regards age, indication of fusion, and diagnosis. All patients in both groups had fusion with autologous iliac crest grafts and posterior instrumentation with posterolateral fusion in the same sitting. Clinical evaluation was done by two questionnaires: the North American Spine Society (NASS) Lumbar Spine Outcome Assessment Instrument and the Nottingham Health Profile (NHP). Fusion rate was evaluated radiologically. Mean clinical follow-up was 5.5 years. There was no statistical difference in the occurrence of complications with both approaches nor with the fusion rates of 92% in group 1 and 84% in group 2 respectively. The minimally invasive extraperitoneal approach for ALIF was associated with significantly less intraoperative blood loss, operation time, and length of the skin incision. In addition, this approach showed significant improvement in postoperative back pain in comparison to the conventional approach for ALIF.


ALIF Conventional Minimally invasive Lumbar spine 


  1. 1.
    Albee FH (1911) Transplantation of a portion of the tibia into the spine for Pott’s disease. JAMA 57:885Google Scholar
  2. 2.
    Andersson BJ (1995) Epidemiology. In: Weinstein JN, Rydevik BL, Sonntag VH (eds) Essentials of the spine. Raven, New York, pp 1–10Google Scholar
  3. 3.
    Barnes B, Rodts GE, McLaughlin MR, Haid RW Jr (2001) Threaded cortical bone dowels for lumbar interbody fusion: over 1-year mean follow up in 28 patients. J Neurosurg 95(1):1–4Google Scholar
  4. 4.
    Capener N (1932) Spondylolisthesis. Br J Surg 19:374–386Google Scholar
  5. 5.
    Castro FP, Hartz RS, Frigon V, Whitecloud TS (2000) Aortic thrombosis after lumbar spine surgery. J Spinal Disord 13:538–540CrossRefPubMedGoogle Scholar
  6. 6.
    Chan FL, Chow SP (1983) Retroperitoneal fibrosis after anterior spinal fusion. Clin Radiol 34:331–335PubMedGoogle Scholar
  7. 7.
    Christensen FB, Bunger CE (1997) Retrograde ejaculation after retroperitoneal lower lumbar interbody fusion. Int Orthop 21:176–180PubMedGoogle Scholar
  8. 8.
    Daltroy LH, Cats-Baril WL, Katz JN, Fossel AH, Liang MH (1996) The North American Spine Society (NASS) Lumbar Spine Outcome Instrument: reliability and validity tests. Spine 21:741–749PubMedGoogle Scholar
  9. 9.
    DeWald CJ, Millikan KW, Hammerberg KW, Doolas A, DeWald RL (1999) An open, minimally invasive approach to the lumbar spine. Am Surg 65:61–68PubMedGoogle Scholar
  10. 10.
    Flynn JC, Hoque MA (1979) Anterior fusion of the lumbar spine. End-result study with long-term follow-up. J Bone Joint Surg Am 61:1143–50PubMedGoogle Scholar
  11. 11.
    Fraser RD (1982) A wide muscle-splitting approach to the lumbosacral spine. J Bone Joint Surg Br 64:44–46PubMedGoogle Scholar
  12. 12.
    Fujimaki A, Crock HV, Bedbrook GM (1982) The results of 150 anterior lumbar interbody fusion operations performed by two surgeons in Australia. Clin Orthop 165:164–167PubMedGoogle Scholar
  13. 13.
    Grob D, Scheier HJ, Dvorak J, Siegrist H, Rubeli M, Joller R (1991) Circumferential fusions of the lumbar and lumbosacral spine. Arch Orthop Trauma Surg 111:20–25PubMedGoogle Scholar
  14. 14.
    Hacker RJ (1997) Comparison of interbody fusion approaches for disabling low back pain. Spine 22:660–666PubMedGoogle Scholar
  15. 15.
    Harmon PH (1960) Anterior extraperitoneal lumbar disc excision and vertebral body fusion. Clin Orthop 18:169–173Google Scholar
  16. 16.
    Hunt SM, McKenna SP, McEwen J, Backett EM, Williams J et al (1980) A quantitative approach to perceived health status: a validation study. J Epidemiol Community Health 34:281–286PubMedGoogle Scholar
  17. 17.
    Ishihara H, Osada R, Kanamori M, Kawaguchi Y, Ohmori K et al (2001) Minimum 10-year follow-up study of anterior lumbar interbody fusion for isthmic spondylolisthesis. J Spinal Disord 14(2):91–99PubMedGoogle Scholar
  18. 18.
    Kaiser MG, Haid RW Jr., Subach BR, Miller JS, Smith CD et al (2002) Comparison of the mini-open versus laparoscopic approach for anterior lumbar interbody fusion: a retrospective review. Neurosurgery 51(1):97–103PubMedGoogle Scholar
  19. 19.
    Kohlmann T, Bullinger M, Kirchberger-Blumstein I (1997) Die deutsche Version des Nottingham Health Profile (NHP): Übersetzungsmethodik und psychometrische Validierung. Soz Praventivmed 42:175–185PubMedGoogle Scholar
  20. 20.
    Kozak JA, O’Brien JP (1990) Simultaneous combined anterior and posterior fusion: an independent analysis of a treatment for the disabled low-back pain patient. Spine 15:322–328PubMedGoogle Scholar
  21. 21.
    Kulkarni SS, Lowery GL, Ross RE, Ravi-Sankar K, Lykomitros V (2003) Arterial complications following anterior lumbar interbody fusion: report of eight cases. Eur Spine J 12(1):48–54PubMedGoogle Scholar
  22. 22.
    Le Huec JC, Liu M, Skalli W, Josse L (2002) Lumbar lateral interbody cage with plate augmentation: in vitro biomechanical analysis. Eur Spine J 11(2):130–136CrossRefPubMedGoogle Scholar
  23. 23.
    Linson MA, Williams H (1991) Anterior and combined anteroposterior fusion for lumbar disc pain. A preliminary study. Spine 16:143–145PubMedGoogle Scholar
  24. 24.
    Mayer HM (1997) A new microsurgical technique for minimally invasive anterior lumbar interbody fusion. Spine 22:691–700PubMedGoogle Scholar
  25. 25.
    O’Brien JP, Dawson MHO, Heard CW, Momberger G, Weatherley CR (1986) Simultaneous combined anterior and posterior fusion: a surgical solution for failed spinal surgery with a brief review of the first 150 patients. Clin Orthop 203:191–195PubMedGoogle Scholar
  26. 26.
    Ogon M, Maurer H, Wimmer C, Landauer F, Sterzinger W et al (1997) Minimally invasive approach and surgical procedure in the lumbar spine. Orthopäde 26:553–561Google Scholar
  27. 27.
    Penta M, Fraser RD (1997) Anterior lumbar interbody fusion. A minimum 10-year follow-up. Spine 22:2429–2434PubMedGoogle Scholar
  28. 28.
    Pose B, Sangha O, Peters A, Wildner M (1999) Validierung des North American Spine Society Instruments zur Erfassung des Gesundheitsstatus bei Patienten mit chronischen Rückenbeschwerden. Z Orthop 137:437–41PubMedGoogle Scholar
  29. 29.
    Rajaraman V, Vingan R, Roth P, Heary RF, Conklin L et al (1999) Visceral and vascular complications resulting from anterior lumbar interbody fusion. J Neurosurg 91:60–64PubMedGoogle Scholar
  30. 30.
    Rajaraman V, Heary RF, Livingston DH (2000) Acute pancreatitis complicating anterior lumbar interbody fusion. Eur Spine J 9:171–173CrossRefPubMedGoogle Scholar
  31. 31.
    Raskas DS, Delamarter RB (1997) Occlusion of the left iliac artery after retroperitoneal exposure of the spine. Clin Orthop 338:86–89PubMedGoogle Scholar
  32. 32.
    Regan JJ, Yuan H, McAfee PC (1999) Laparoscopic fusion of the lumbar spine: minimally invasive spine surgery. A prospective multicenter study evaluating open and laparoscopic lumbar fusion. Spine. 24:402–411Google Scholar
  33. 33.
    Sasso RC, Burkus KJ, Le Huec JC (2003) Retrograde ejaculation after anterior lumbar interbody fusion. Transperitoneal versus Retroperoitoneal Exposure. Spine 28(10):1023–1026CrossRefPubMedGoogle Scholar
  34. 34.
    Seelig W, Nidecker A (1989) Pain following operations of the lumbar of the lumbar spine. The ‘‘failed back surgery syndrome’’. Z Orthop 127:346–353PubMedGoogle Scholar
  35. 35.
    Slosar PJ, Reynolds JB, Schofferman J, Goldthwaite N, White AH et al (2000) Patient satisfaction after circumferential lumbar fusion. Spine 25:722–726PubMedGoogle Scholar
  36. 36.
    Stauffer RN, Coventry MB (1972) Anterior interbody lumbar spine fusion. J Bone Joint Surg Am 54:756–768PubMedGoogle Scholar
  37. 37.
    Takahashi K, Kitahara H, Yamagata M, Murakami M, Takata K et al (1990) Long-term results of anterior interbody fusion for treatment of degenerative spondylolisthesis. Spine 15:1211–15PubMedGoogle Scholar
  38. 38.
    Wimmer C, Krismer M, Gluch H, Sterzinger W, Ogon M (1997) Advantages and disadvantages of retro- and transperitoneal approach for fusion of the presacral intervertebral disk. Orthopade 26:563–567CrossRefPubMedGoogle Scholar
  39. 39.
    Zdeblick TA, David SM (2000) A Prospective Comparison of Surgical Approach for Anterior L4-L5 Fusion. Laparoscopic versus Mini Anterior Lumbar Interbody Fusion. Spine 25:2682–2687CrossRefPubMedGoogle Scholar
  40. 40.
    Zucherman JD, Zdeblick TA, Bailey SA, Mahvi D, Hsu KY et al (1995) Instrumented laparoscopic spinal fusion: Preliminary results. Spine 2:2029–2035Google Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • V. Saraph
    • 1
    • 2
    Email author
  • C. Lerch
    • 1
  • N. Walochnik
    • 1
  • C. M. Bach
    • 1
  • M. Krismer
    • 1
  • C. Wimmer
    • 1
  1. 1.Department of Orthopaedic SurgeryLeopold Franzens UniversityInnsbruckAustria
  2. 2.GrazAustria

Personalised recommendations