LAPAROSCOPIC DISKECTOMY WITH ANTERIOR INTERBODY FUSION OF L5-S1

Background: A laparoscopic approach to the spine for the performance o f a minimally invasive discectomy was first described in 1991. Since t hat time, a number of approaches to laparoscopic discectomy have appea red in the literature. Although these reports demonstrate the ability to approach the spine through a laparoscopic technique, they do not ad dress the issues of loss of disc space, lumbar instability, and the ne ed for interbody fusion. Methods: Described is a technique of laparosc opic discectomy with interbody fusion that has been performed successf ully in 75 patients. Although a carbon fiber implant was utilized to a id in the fusion process, the technique can equally be performed using donor bone as the interbody support. In the 75 patients attempted, 73 procedures were successfully completed via the laparoscopic approach. One patient was converted to an open anterior approach due to extensi ve pelvic adhesions from prior surgery. A second patients procedure wa s aborted after the diagnostic laparoscopy demonstrated dense presacra l scarring from a previous gynecological procedure. Results: There wer e no major complications in the series. Two patients with high riding bladders sustained bladder lacerations that were recognized and repair ed with simple suture closure. There were no bowel injuries, and more importantly, no major vessel injury. The patients were discharged from the hospital on an average within 36 hours, with a return to work ave raging between 2-4 weeks depending on the patients type of work. Using a modified pain score for evaluation, post operative pain was reduced by 75%. Conclusions: From this study, it is concluded that laparoscop ic discectomy with interbody fusion is not only feasible, but appears to give good results with follow up extending out beyond two years. Is sues regarding the use of carbon fiber cages vs. bone and indications of the procedure are independent of the laparoscopic approach and are addressed extensively in the orthopedic literature. It can be conclude d that when there is surgical indication for L5-S1 discectomy, that a laparoscopic approach with interbody fusion may become the procedure o f choice.