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Minimally Invasive Lumbar Spinal Fusion

Dr. Eck is Chief Resident, Department of Orthopaedic Surgery, Memorial Hospital, York, PA. Dr. Hodges is Orthopaedic Spine Surgeon, Center for Sports Medicine and Orthopaedics, Chattanooga, TN. Dr. Humphreys is Orthopaedic Spine Surgeon, Center for Sports Medicine and Orthopaedics.

Dr. Hodges and Dr. Humphreys or the department with which they are affiliated have received royalties from Biomet and serve as consultants to or are employees of Medtronic Sofamor Danek. Neither Dr. Eck nor the department with which he is affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Reprint requests: Dr. Hodges, Center for Sports Medicine and Orthopaedics, 2415 McCallie Avenue, Chattanooga, TN 37404.

Minimally invasive techniques for lumbar spine fusion have been developed in an attempt to decrease the complications related to traditional open exposures (eg, infection, wound healing problems). Anterior minimally invasive procedures include laparoscopic and mini-open anterior lumbar interbody fusion as well as the lateral transpsoas and percutaneous presacral approaches. Posterior techniques typically use a tubular retractor system that avoids the muscle stripping associated with open procedures. These techniques can be applied to both posterior and transforaminal lumbar interbody fusion procedures. Many initial reports have shown similar clinical results in terms of spinal fusion rates for both traditional open and minimally invasive posterior approaches. However, the anterior minimally invasive procedures are often associated with significantly greater incidence of complications and technical difficulty than their associated open approaches. There is a steep learning curve associated with minimally invasive techniques, and surgeons should not expect to master them in the first several cases.