To report a series of 38 patients presenting retroperitoneoscopic inter-body fusion of the lumbar spine from L2 to L5, performed between 1995 and 1998.
This series included 25 women and 13 men aged from 16 to 74 years (mean age: 48.5 years). Surgery was performed in 32 patients for primary degenerative or post-operative instability of the lumbar spine, in five patients for painful sequels of burst fracture, and in one patient for sequels of disc infection. The main complaint was lumbar pain but a real sciatic pain was present in nine patients and was not a contraindication for this surgery. Standard X-rays were performed for each patient, and MRI performed in 30 patients confirmed the diagnosis and was also useful in determining vascular abnormalities. A cast immobilisation of the lumbar spine was done as a preoperative test in every patient.
Forty-two levels were fused: 31 with a cage filled with cancellus bone and screwed between the end plates, and 11 with cancellus bone alone or in association with bone substitute, such as beta TCP. Post-operative complications included only a transient paresthesia of the thigh in two cases and a chyloretroperitoneum spontaneously resolutive. After 2.3 months of plaster immobilisation with a follow-up of 11.4 months, patient satisfaction rate was 84.5%, with 68.5% reporting no further back pain. The improvement was estimated by Prolo score. Fusion was considered effective by X-ray examination in all patients with an increase in the intervertebral space of 35% and a recovery of the local lordosis of 15%.
Retroperitoneoscopic surgery is an elegant and secure method for lumbar interbody fusion of L2 to L5 with very few postoperative complications.