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Lower Spine News

New Advance in Spinal Fusion

Surgery to fuse the lumbar spine is changing all the time. Early operations made a long cut from behind to open the back (posterior approach). There are problems with this method. The spinal cord or spinal nerves can get damaged. Scar tissue can wrap itself around the nerve tissue, causing chronic pain. The muscles on either side of the backbone can be injured, too.

Today the operation can be done from the front of the body. This is called an anterior approach. The disc is removed and an implant or cage is put between the two vertebrae. This operation is called an anterior lumbar interbody fusion, or ALIF. It avoids the problems with the posterior approach.

Now doctors are using a laparoscope to do this surgery. This tool allows them to enter the body with one puncture hole. The doctor can fuse the spine without cutting open the body. The authors of this study report the results of ALIF using the standard mini- open operation versus the newer, laparoscopic method. They want to know if there's any real advantage to the laparoscopic method.

A few other studies have looked at the results of laparoscopic ALIF. Only a small number of patients were included over a short amount of time. In this study, 54 patients were followed for two years. Everyone had a fusion of the L5/S1 level. One group had the mini- open fusion with a five-centimeter incision. The laparoscopic group had one puncture near the belly button.

The authors report no difference in pain levels between the two methods. Patients in both groups were equally satisfied with the results. The same number of problems occurred after the operation in both groups.

The laparoscopic ALIF is a more difficult operation. Since it doesn't give better results, the authors wonder if it's worth using. Advanced technology makes the laparoscopic ALIF possible. It's not necessarily better than the open-mini method. More study is needed in this area to guide physicians in making this decision.


Sang Ki Chung, et al. Comparative Study of Laparoscopic L5-S1 Fusion Versus Open Mini- ALIF, with a Minimum 2-Year Follow-up. In European Spine Journal. December 2003. Vol. 12. No. 6. pp. 613-617.

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