Laparoscopic Lumbar Spinal Techniques

Minimally invasive spine surgery is the performance of surgery through small incision(s), usually with the aid of endoscopic visualization, that is, devices designed for viewing internal portions of the body. Laparoscopic anterior interbody techniques of the lumbar spine are minimally invasive techniques for the lower region of the spine.

Laparoscopic minimally invasive techniques offer several advantages including:

• Reduced surgical complications
• Reduced surgical blood loss
• Reduced use of postoperative pain medicines
• Avoidance of fusion disease
• Reduced length of hospital stay
• Increased speed of return to daily activities

The roles of Lumbar Laparoscopic Anterior Interbody Techniques are to obtain fusion of the symptomatic spinal motion segment, decompression, and to minimize pain, narcotic use, and risks of immobility.

Doctors use various tools to assess patients for Laparoscopic spine techniques including Plain Radiographs (X-rays), CT Scans, MRI, and Discogram Pain Study.

Laparoscopic Anterior Interbody Techniques are an option for patients when one of the following general indications is evident:

• one or two-level disc disease (L2 to S1)
• when there is significant disc-space narrowing
• a revision of failed posterior fusions
• grade I spondylolisthesis
• segmental instability

Laparoscopic Anterior Interbody Techniques are not an option for patients when one of the following general indications is evident:

• active infection at the operative site
• active cutaneous, pulmonary, or urologic infection
• metabolic bone disease -loss of quantity or quality of vertebral bone stock likely to compromise fixation
• presence of primarily nonorganic symptoms (disproportionate pain)

Patients may not be candidates for Laparoscopic Anterior Interbody Techniques if any of the following situations exist:

• Medical condition interferes with the patient's ability to participate in a postoperative management program (neuromuscular compromise, muscle loss).
• Circulatory problems (thrombophlebitis, lymphedema, or vascular insufficiency at the implant site)
• Symptomatic cardiac disease
• Active malignancy
• Obesity (greater than 40% over ideal for age and height)
• Greater than Grade I spondylolisthesis at the affected level
• Pregnancy
• Multilevel motion-segment pain
• Metal allergy or intolerance (for metallic devices)
• Patient is experiencing a high level of emotional stress
• Tobacco use
• Medical condition requiring postoperative medications that interfere with bone healing/fusion, such as nonsteroidal anti-inflammatory drugs and steroids
• Patient is not a candidate for laparoscopic fusion (laparoscopist consultation).

Patient Recovery

Mobilization

On the day of the surgery the patient is usually mobilized to a chair and ambulates with assistance 3-4 times. If the patient returns to the nursing unit by early afternoon, and is recovering well from the anesthesia, PT may assess mobilization, body mechanics, and activities of daily living on the day of surgery. The surgeon decides if the patient needs a brace. Discharge Discharge is usually one day after the surgery, although some patients are discharged on the afternoon of surgery if they are independent in ambulation, taking P.O. well, and oral pain killers are effective.

Exercises

After the first postoperative visit, patients will usually be encouraged to do at least one of the following: walk with the goal of 1-2 miles a day, swim and/or water walk, and begin abdominal isometrics 6 weeks after postoperative visit (unless the surgeon has concerns on the fixation).

Typical rehabilitation to restore the true spinal range of motion and stability begins at 12 weeks. Initially, patients are encouraged to do lumbar range of motion and stability exercises 3 times per week for 4 weeks. Then, patients are instructed to maintain their independent lumbar range of motion and stability exercise program indefinitely.

Editors Note: This is an excellent patients' overview of Laparoscopic interbody fusion. Be sure to check your surgeon's preference of techniques, experience, and outcomes.