Instrumented laparoscopic spinal fusion: Preliminary results

James F. Zucherman*, Thomas A. Zdeblick, Susan A. Bailey, David Mahvi, Ken Y. Hsu, Doug Kohrs

*Corresponding author for this work

Research output: Contribution to journalArticle

145 Citations (Scopus)

Abstract

Study Design. Seventeen consecutive patients underwent laparoscopic instrumented interbody fusions using custom-designed delivery instrumentation and "BAK" fusion cages; both are manufactured by Spine tech and the former was developed by the authors. The cases were performed at two spine center under Food and Drug Administration Investigational device evaluation clinical trials. Objectives. We expect this approach will maintain a high fusion rate with diminished hospitalization time, recovery time, patient discomfort, and expense. The rehabilitative aspects of the procedure are a great improvement over traditional fusion approaches. Summary and Background Data. Extraordinary advances in many endoscopic surgical fields have resulted in lowered morbidity, expense, and suffering associated with their open surgery counterparts. The authors have developed prototype of delivery instruments for the current laparoscopic fusion cage delivery system. Methods. The procedure is performed transperitoneally with carbon dioxide insufflation to enable videoassisted visualization through a 10-mm endoscope. Three 10-mm incisions and one 13- to 20-mm incision are required for one-level procedures. Two hollow titanium-threaded interbody implants are packed with autologous bone and inserted into the diseased interspace. Results. Seventeen patients, with an average follow-up period of 8 months and range of 6-12 months, underwent the procedure. There were 14 single-level fusions and three two-level fusions, all involving L4-S1 levels. There were two cases that required conversion to open procedures without sequelae; two patients had remote donor site wound infections eradicated with incision and drainage and antibiotics, and one patient required subsequent posterior spinal decompression because of a displaced endplate fracture. Average hospital stay was an average of 2 days, excluding two patients with complications and very prolonged stay. Conclusions. Although this procedure is associated with a long learning curve, the technique, once mastered, is effective and advantageous over current approaches to lumbar fusion. Operative time and hospital stay are expected to decrease with future instrumentation development and surgeon experience.

Original languageEnglish (US)
Pages (from-to)2029-2034
Number of pages6
JournalSpine
Volume20
Issue number18
StatePublished - Jan 1 1995

Fingerprint

Spinal Fusion
Length of Stay
Spine
Conversion to Open Surgery
Insufflation
Learning Curve
Endoscopes
Wound Infection
United States Food and Drug Administration
Operative Time
Decompression
Titanium
Carbon Dioxide
Drainage
Hospitalization
Tissue Donors
Clinical Trials
Anti-Bacterial Agents
Morbidity
Bone and Bones

Keywords

  • Cage impiants
  • Interbody fusion
  • Laparoscopic
  • Lumbar spine

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine
  • Physiology

Cite this

Zucherman, J. F., Zdeblick, T. A., Bailey, S. A., Mahvi, D., Hsu, K. Y., & Kohrs, D. (1995). Instrumented laparoscopic spinal fusion: Preliminary results. Spine, 20(18), 2029-2034.
Zucherman, James F. ; Zdeblick, Thomas A. ; Bailey, Susan A. ; Mahvi, David ; Hsu, Ken Y. ; Kohrs, Doug. / Instrumented laparoscopic spinal fusion : Preliminary results. In: Spine. 1995 ; Vol. 20, No. 18. pp. 2029-2034.
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Zucherman, JF, Zdeblick, TA, Bailey, SA, Mahvi, D, Hsu, KY & Kohrs, D 1995, 'Instrumented laparoscopic spinal fusion: Preliminary results', Spine, vol. 20, no. 18, pp. 2029-2034.

Instrumented laparoscopic spinal fusion : Preliminary results. / Zucherman, James F.; Zdeblick, Thomas A.; Bailey, Susan A.; Mahvi, David; Hsu, Ken Y.; Kohrs, Doug.

In: Spine, Vol. 20, No. 18, 01.01.1995, p. 2029-2034.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Instrumented laparoscopic spinal fusion

T2 - Preliminary results

AU - Zucherman, James F.

AU - Zdeblick, Thomas A.

AU - Bailey, Susan A.

AU - Mahvi, David

AU - Hsu, Ken Y.

AU - Kohrs, Doug

PY - 1995/1/1

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N2 - Study Design. Seventeen consecutive patients underwent laparoscopic instrumented interbody fusions using custom-designed delivery instrumentation and "BAK" fusion cages; both are manufactured by Spine tech and the former was developed by the authors. The cases were performed at two spine center under Food and Drug Administration Investigational device evaluation clinical trials. Objectives. We expect this approach will maintain a high fusion rate with diminished hospitalization time, recovery time, patient discomfort, and expense. The rehabilitative aspects of the procedure are a great improvement over traditional fusion approaches. Summary and Background Data. Extraordinary advances in many endoscopic surgical fields have resulted in lowered morbidity, expense, and suffering associated with their open surgery counterparts. The authors have developed prototype of delivery instruments for the current laparoscopic fusion cage delivery system. Methods. The procedure is performed transperitoneally with carbon dioxide insufflation to enable videoassisted visualization through a 10-mm endoscope. Three 10-mm incisions and one 13- to 20-mm incision are required for one-level procedures. Two hollow titanium-threaded interbody implants are packed with autologous bone and inserted into the diseased interspace. Results. Seventeen patients, with an average follow-up period of 8 months and range of 6-12 months, underwent the procedure. There were 14 single-level fusions and three two-level fusions, all involving L4-S1 levels. There were two cases that required conversion to open procedures without sequelae; two patients had remote donor site wound infections eradicated with incision and drainage and antibiotics, and one patient required subsequent posterior spinal decompression because of a displaced endplate fracture. Average hospital stay was an average of 2 days, excluding two patients with complications and very prolonged stay. Conclusions. Although this procedure is associated with a long learning curve, the technique, once mastered, is effective and advantageous over current approaches to lumbar fusion. Operative time and hospital stay are expected to decrease with future instrumentation development and surgeon experience.

AB - Study Design. Seventeen consecutive patients underwent laparoscopic instrumented interbody fusions using custom-designed delivery instrumentation and "BAK" fusion cages; both are manufactured by Spine tech and the former was developed by the authors. The cases were performed at two spine center under Food and Drug Administration Investigational device evaluation clinical trials. Objectives. We expect this approach will maintain a high fusion rate with diminished hospitalization time, recovery time, patient discomfort, and expense. The rehabilitative aspects of the procedure are a great improvement over traditional fusion approaches. Summary and Background Data. Extraordinary advances in many endoscopic surgical fields have resulted in lowered morbidity, expense, and suffering associated with their open surgery counterparts. The authors have developed prototype of delivery instruments for the current laparoscopic fusion cage delivery system. Methods. The procedure is performed transperitoneally with carbon dioxide insufflation to enable videoassisted visualization through a 10-mm endoscope. Three 10-mm incisions and one 13- to 20-mm incision are required for one-level procedures. Two hollow titanium-threaded interbody implants are packed with autologous bone and inserted into the diseased interspace. Results. Seventeen patients, with an average follow-up period of 8 months and range of 6-12 months, underwent the procedure. There were 14 single-level fusions and three two-level fusions, all involving L4-S1 levels. There were two cases that required conversion to open procedures without sequelae; two patients had remote donor site wound infections eradicated with incision and drainage and antibiotics, and one patient required subsequent posterior spinal decompression because of a displaced endplate fracture. Average hospital stay was an average of 2 days, excluding two patients with complications and very prolonged stay. Conclusions. Although this procedure is associated with a long learning curve, the technique, once mastered, is effective and advantageous over current approaches to lumbar fusion. Operative time and hospital stay are expected to decrease with future instrumentation development and surgeon experience.

KW - Cage impiants

KW - Interbody fusion

KW - Laparoscopic

KW - Lumbar spine

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Zucherman JF, Zdeblick TA, Bailey SA, Mahvi D, Hsu KY, Kohrs D. Instrumented laparoscopic spinal fusion: Preliminary results. Spine. 1995 Jan 1;20(18):2029-2034.