Laparoscopic Anterior Lumbar Fusion
This procedure is used as any other anterior spinal fusion, but is performed using the laparoscope. This is a telescopic device which allows the surgeon to see the structures within the body on a video screen in great detail. It has been used in abdominal surgery for many years with great success, both in terms of shorter hospital stay and in minimising scarring. Its application in spinal surgery has been relatively more recent, with several large series of patients now published having undergone this procedure.
The fusion performed laparoscopically is exactly the same as that performed using the conventional "open" procedure and therefore has a similar success rate.
What are the risks of this operation?
| Risk | Cause |
% Risk (note figures vary) |
| Nerve injury/paralysis | Damage to the nerve whilst removing disc/bone or inserting fusion devices | <1 |
| Fluid leak | Small tear in the nerve sheath allowing leakage of cerebrospinal fluid | <1 (But higher if previous surgery |
| Infection | Contamination during surgery or, rarely, late infection via the blood | Approx 1 |
| Back pain | Some patients will develop back pain due to the stretching of the spine | Transient and dependent upon fitness |
| Adjacent disc damage | The stiffening effect of the fusion puts more pressure on the disc above (or below) | 4 - 12% (some papers say higher) |
| Failure of fusion | If the bone graft does not heal, the pain may return | Up to 30%, depending on technique used |
| Bowel injury | Bowel is retracted during surgery | <1 |
| Bladder/ureter injury | Structures are retracted during surgery | <1 |
| Impotence | Retraction or injury to a small nerve in front of the spine leads to retrograde ejaculation in men | Approx 1 with the retro-peritoneal approach |
| Warm leg | The sympathetic nerve runs alongside the lumbar discs. If damaged the left leg (usually) will feel warmer for some months after the operation | 1 - 5 (but higher if previous surgery |
| Wound pain | Surgery | All to some extent |
| Conversion | If the view is difficult occasionally the surgeon needs to make an incision | Approx 1 |
Click here to view pictures of the procedure