[Video-assisted anterior extra-peritoneal approach of the inferior lumbar spine]

The aim of this study is to describe a new operative technique for anterior lumbar and lumbosacral fusion using a video assisted anterior extra peritoneal approach.

Ten patients were operated on. There were 3 men and 7 females. Age at operation ranged from 18 to 55. There were 8 degenerative and 2 iatrogenic discopathias. Fused level was L4-L5 (5 patients) and L5-S1 (5 patients). Average hospital stay was 6 days.

A small vertical 4-5 cm incision is made on the mid line, centered on the umbilicus for the approach to L4-L5, and between the umbilicus and pubis for the L5-S1 approach. The peritoneum is cleaved from the abdominal wall on the left side, and the anterior aspect of the spine is progressively freed. The endoscope is laterally introduced. It gives an excellent view of the prevertebral area. A specially designed retractor is used for retraction of the iliac vessels. Following removal of the intervertebral disc, a special spreader allows obtention of a normal intervertebral space height and insertion of an autogenous iliac graft.

Anterior approach of the lumber intervertebral discs allows disc resection and grafting in a strict middle position. The extra peritoneal simplifies the postoperative course and avoids digestive and septic complications of the transperitoneal approach. The video assistance gives excellent exposure by a small incision with direct visual control; it should be differentiated form the true endoscopic lumbar surgery which is performed under C02 insufflation, with exclusive endoscopic vision and with instruments introduced through trocards.

Video-assistance allows an approach to the lumbar and lumbosacral spine by an anterior non invasive extra peritoneal approach, with low morbidity, increasing the possibilities of anterior fusion in the treatment of lumbar discopathias and instability without radicular compromise.