VIDEO-ASSISTED ANTERIOR EXTRA-PERITONEAL APPROACH OF THE LUMBAR SPINE

Purpose of the study The aim of this study is to describe a new operat ive technique for anterior lumbar and lumbosacral fusion using a video assisted anterior extra peritoneal approach. Material Ten patients we re operated on. There were 3 men and 7 females. Age at operation range d from 18 to 55. There were 8 degenerative and 2 iatrogenic discopathi as. Fused level was L4-L5 (5 patients) and L5-S1 (5 patients). Average hospital stay was 6 days. Methods A small vertical 4-5 cm incision is made on the mid line, centered on the umbilicus for the approach to L 4-L5, and between the umbilicus and pubis for the L5-S1 approach. The peritoneum is cleaved from the abdominal wall on the left side, and th e anterior aspect of the spine is progressively freed. The endoscope i s laterally introduced. It gives an excellent view of the prevertebral area. A specially designed retractor is used for retraction of the il iac vessels. Following removal of the intervertebral disc, a special s preader allows obtention of a normal intervertebral space height and i nsertion of an autogenous iliac graft. Discussion Anterior approach of the lumber intervertebral discs allows disc resection and grafting in a strict middle position, The extra peritoneal simplifies the postope rative course and avoids digestive and septic complications of the tra nsperitoneal approach. The video assistance gives excellent exposure b y a small incision with direct visual control; it should be differenti ated from the true endoscopic lumbar surgery which is performed under C02 insufflation, with exclusive endoscopic vision and with instrument s introduced through trocards. Conclusion Video-assistance allows an a pproach to the lumbar and lumbosacral spine by an anterior non invasiv e extra peritoneal approach, with low morbidity, increasing the possib ilities of anterior fusion in the treatment of lumbar discopathias and instability without radicular compromise.