Lateral Lumbar Interbody Fusion (XLIF)

GOAL:

An eXtreme Lateral Interbody Fusion (XLIF) is a procedure that focuses on releasing pressure on spinal nerves caused by a herniated disc, bulging disc, or other anatomical abnormality.

BENEFITS:

The XLIF (eXtreme Lateral Interbody Fusion) procedure provides relief to patients who cannot tolerate a larger, open back surgery because of the increased risks of longer anesthesia time, blood loss, hospitalization, and recovery.

It is also a less invasive alternative for patients who have lived with back or leg pain through years of failed treatments, including steroid injections, physical therapy, and pain medication.

In addition to alleviating neural compression, this surgery also immobilizes the fused section of the spine so that pain caused by movement is reduced or eliminated.

It is also beneficial because it may allow for less tissue trauma, less scarring, shorter hospital stays and less postoperative discomfort, resulting in a decreased need for post-operative pain medication.

This procedure is used only in the lumbar spine fusing one or more lumbar vertebra and removing the discs between them. It cannot treat conditions at the lowest level of the spine, L5-S1 or for some people at L4-L5.

CONDITIONS:

It is used to treat specific types of lumbar spinal disorders such as:

  • Lumbar degenerative disc disease
  • Spondylolisthesis
  • Scoliosis and spine deformity
  • Recurrent lumbar disc herniation’s
  • Lumbar stenosis

PROCEDURE:

In a lateral lumbar interbody fusion, the surgeon takes a side approach and centers the incision over the patient’s flank.

Using this approach, the surgeon can reach the vertebrae and intervertebral disks without moving the nerves or opening up muscles in the back.

A fusion involves the removal of the disc causing nerve impingement ( a discectomy), and then the fusion of the two vertebrae on either side of the disc space with bone grafts and hardware such as a metal, plastic, or bone spacer implanted between the two adjoining vertebrae.

These spacers, or “cages,” usually contain bone graft material which promotes bone healing and facilitates the fusion.

After the cage is inserted, the spine is stabilized using metal screws, plates, and rods.

The XLIF procedure includes the use of advanced nerve monitoring system (EMG) and allows the surgeon to have accurate, reproducible, real-time feedback about nerve health, location, and function, reducing the incidence of nerve injury during surgery.

RISKS:

Possible risks and complications associated with the XLIF procedure:

  • Persistent pain/continued pain after surgery
  • Failure to fuse (pseudo arthrosis, or non-union)
  • Infection
  • Muscle weakness
  • Vascular injury (injury of the blood vessels)
  • Deep vein thrombosis (clotting)
  • Persistent pain at the site of bone graft harvest (in the hip)
  • Further progression of existing spinal disease

RECOVERY:

Some patients who undergo an XLIF procedure are able to return home the same day as the surgery; others require a stay of a few days or a week in the hospital.

This depends on the number of vertebral levels that were fused, the severity of the problem and the patient’s overall health.

Many patients notice an improvement of their pre-operative symptoms (i.e., leg pain, etc.) immediately after surgery or gradually over a few weeks.

Pain at the incision sites after surgery is normal and is well controlled with oral pain medication that is prescribed upon discharge from the hospital.

Because the XLIF surgery only splits muscles, patients are able to get up and walk around the night after they have had surgery.

Most patients are able to return to their normal activities within a few months of surgery.