Assessing the efficacy of the minimally invasive extraperitoneal approach in anterior lumbar interbody fusion and artificial disc replacement

Abstract

Abstract Objective To investigate the utilization of the extraperitoneal approach in anterior lumbar spine surgery and to compare the outcomes of two surgical techniques. Methods 56 patients (30 males, 26 females) underwent minimally invasive extraperitoneal anterior lumbar surgery (2018–2021). Diagnoses: 24 spondylolisthesis, 26 discogenic pain, 3 spinal stenosis, 3 revision surgeries. Procedures: 29 intervertebral cage fusions, 27 artificial disc replacements (L4/5, L5/S1). Parameters: op duration, blood loss, complications, recovery, incision, abdominal pain, hospital stay, pre/post-op Visual Analog Scale (VAS) scores two weeks after surgery. Results Both groups had successful surgeries with no incision extension. Average operation time was 86.5 ± 12.1 minutes, with 130 ml blood loss. Post-op recovery averaged 3 days, and incisions were 6.5 cm long. Average post-op hospital stay was 7 days. Pre-op Visual Analog Scale (VAS) score was 7, decreasing to 4 two weeks post-op. In the Cage implantation group, average operation time was 86 ± 12.8 minutes, with 100 ml blood loss. Patients resumed ambulation in about 3 days, with a 6.5 cm incision. Average post-op hospital stay was 7 days. Pre-op VAS score averaged 7, decreasing to 4 two weeks post-op. In the artificial lumbar disc replacement group, average operation time was 87 ± 11.5 minutes, with 140 ml blood loss. Ambulation typically resumed in about 3 days, with a 6.5 cm incision. Average post-op hospital stay was 7 days. Pre-op VAS score was 7, decreasing to 4 two weeks post-op. Complications included one vena cava bifurcation tear, two peritoneal tears, three cases of post-op abdominal distention, and five cases of post-op low-grade fever. In the Cage implantation group, there was one venous lumen bifurcation tear, no peritoneal tears, two cases of post-op abdominal distention, and three cases of post-op low-grade fever. In the artificial lumbar disc replacement group, there were no cases of vena cava bifurcation tear, two peritoneal tears, one case of post-op abdominal distention, two cases of post-op low-grade fever, and no instances of retrograde ejaculation in selected male patients. Conclusion The implementation of two minimally invasive extraperitoneal surgical techniques has yielded favorable surgical outcomes, meriting consideration for broader clinical adoption.