Laparoscopic anterior lumbar interbody fusion: a review of outcome studies

Laparoscopic anterior lumbar interbody fusion (LALIF) was first reported in 1995. It was expected to reduce the morbidity of an open ALIF, while maintaining its advantages. About a decade after its debut, the feasibility and short-term efficacy of the LALIF has been recognized. Currently, other minimally-invasive surgical options have been made available for the treatment of lumbar degenerative disc disease, and thus the role of LALIF has not been established in view of these other methods. The authors aim to clarify this, by conducting a review of the literature particularly on the outcome studies of LALIF. Several comparative studies showed that at the L5-S1 disc level, there was no marked difference between LALIF and the open or mini-open ALIF in terms of short-term efficacy, i. e., operative time, blood loss, and length of hospital stay. With regard to the complication rate, however, there was a higher incidence of retrograde ejaculation in LALIF. At the L4-L5 and L4-L5/L5-S1 disc levels, the complication rate and conversion rate to open surgery was high in LALIF, and many authors were not impressed with the LALIF at these levels. Several case series showed that the LALIF yielded excellent perioperative outcomes in the hands of experienced endoscopic spine surgeons at both the L5-S1 and L4-L5 disc levels. No conclusion regarding either the superiority or inferiority of LALIF to the open or mini-open ALIF can be drawn, because of the lack of data with a high-level of evidence. It cannot be denied, however, that some spine surgeons are abandoning this procedure and switching to the mini-open ALIF. Treatment of lumbar degenerative disc disease itself has been changing rapidly, as represented by the recent emergence of the lumbar artificial disc, and the future role of LALIF remains to be followed closely.