Although safer than anterior retroperitoneal approach, extreme lateral interbody fusion still bears risk for major vascular injury.

Introduction Microscopically assisted retroperitoneal laparotomy is a minimally invasive modification of a standard approach for anterior lumbar interbody fusion (ALIF). In this study, we compare the peri- and immediate postoperative results of standard versus microscopically assisted L5–S1 interbody fusion. Patients and Methods A total of 20 patients with low back pain because of the degenerative disc disease and/or spondylolisthesis were included in the study. Overall, 10 patients were submitted to a single-stage microscopically assisted left-retroperitoneal interbody fusion and 10 patients were submitted to a single-stage standard left-retroperitoneal interbody fusion. All patients were instrumented posteriorly with screw and rod system. Data were collected for vascular and visceral injuries, blood loss, operating time, walk-out-of-bed time, peristalsis recovery, and initial 48 hours pain levels. Results Significant differences were found for vascular lesion and blood loss between the two groups with the standard laparotomy group being on the worse side. Furthermore, patients subjected to a microscopically assisted approach showed a more rapid recovery of intestinal peristalsis, a reduced walk-out-of-bed time, and a lower intensity of perceived pain in the first 48 hours after the surgery. Conclusion The results of this study indicate the minimally invasive approach for ALIF as an equally efficient but much safer approach as compared with the standard laparotomy approach. Reduction of complications and a shorter in-hospital stay contribute on lowering the costs of the treatment making it not only clinically, but also economically more suitable surgical choice.