Laparoscopic approach to anterior lumbar spine fusion

The authors present their experience in 50 patients submitted to Laparoscop ic Anterior Lumbar Fusion. Among them 30 were on L5S1 level submitted to tr ansperitoneal access and the remaining 20 patients were submitted to retrop eritoneal access for higher levels. Regarding to the indications, Degenerat ive Disk Desease with instability and Failed Back Syndrome were found. We p erformed this procedure in 12 cases with Spondilolistesis. Clinical picture presented as discogenic and invalidant lumbar pain in all cases, We used D iscography in only 3 cases to discover the affected disk. Time of surgery a nd hospitalization decreased with the learning curve. Fusion rate was 90% i n 6 months. Complications in transperitoneal approach were: 1)Iliac vein in jury(2). 2)Pulmonary embolism(1), 3)Small bowel perfuration(1). 4) Non-cons olidation(1). In the retroperitoneal approach cases the complications were: 1) Ureteral injury(1). 2) Psoas muscle abcess(1). 3)Bleeding with converti on to open surgery(1). After getting the learning curve, we can conclude th e less invasiveness of the laparoscopic approach that leads to less postope rative pain and swifter return to activities but 2 major topic must be reme mbered: 1) Selective surgical indication 2) Long and multidisciplinary lear ning curve, including how to recognize and treat serious complications.