XLIF: Lumbar Spinal Fusion

The XLIF (eXtreme Lateral Interbody Fusion) is an approach to spinal fusion in w

hich the surgeon accesses the intervertebral disc space and fuses the lumbar spi
ne (low back) using a surgical approach from the side (lateral) rather than from
the front (anterior) or the back (posterior).
It is a minimally invasive type of spine surgery designed to accomplish a spinal
fusion with several advantages including:

Minimal tissue damage

Minimal blood loss

Small incisions and scars

Minimal post-operative discomfort

Relatively quick recovery time and return to normal function.

Because of the above factors, it is one of a number of options for spinal fusion
that are relatively minimally invasive.
The XLIF procedure can be used for a variety of lumbar spinal disorders that may
be treated with spinal fusion. These conditions may include:

Degenerative disc disease

Degenerative scoliosis

Low grade spondylolisthesis

Spinal deformity

Foraminal stenosis (a type of spinal stenosis) requiring disc height restoration

Recurrent lumbar disc herniations

A thoracic disc herniation

Instances in which a patient could not have an XLIF procedure would include:

A fusion in the disc space between the 5th lumbar and 1st sacral vertebrae (L5-S
1) because it is below the level of the pelvic brim, which inhibits access to th
e disc space from the side.

For some patients with a low riding L4-L5 level, access from the side through an
XLIF may also not be an option

Some deformities with significant rotation

High grade spondylolisthesis

Bilateral retroperitoneal scarring (from a prior abscess or abdominal surgery)

There are a series of steps performed to complete an XLIF spinal fusion:

First, the patient will be positioned lying on his or her side. Then the surgeon
will use X-rays to locate the disc that will be removed.

Once the disc is located, the surgeon will mark the skin with a marker directly
above the disc.

Then the surgeon will make a small incision (cut) in the flank (low back region
of the trunk) and use his or her finger to push away the peritoneum (sac coverin
g the abdominal organs) from the abdominal wall.

The surgeon will make a second incision directly on the side of the patient.

The surgeon will then insert a tube-like instrument known as a dilator into this
incision.

The surgeon will use X-rays to make sure that this dilator is in a good position
above the disc.

The surgeon will then insert a probe (blunt tool) through a muscle known as the
psoas muscle. The psoas muscle is a large muscle that runs from the lower spine,
wrapping around the pelvic area and attaches at the hip.
Possible risks and complications associated with the XLIF include but are not li
mited to:

Persistent pain/continued pain after surgery

Failure to fuse (pseudoarthrosis, or non-union)

Infection

Muscle weakness

Vascular injury (injury of the blood vessels)

Neurologic injury (nerve or spinal cord damage)

Urinary tract infection

Stroke

Pneumonia

Deep vein thrombosis (clotting)


Persistent pain at the site of bone graft harvest (in the hip)

Further progression of existing spinal disease

With an XLIF procedure, the following recovery factors are typical:

Many patients notice a difference in their pre-operative symptoms (i.e., leg pai
n, etc.) immediately after surgery. In other patients, pre-operative symptoms of
ten go away gradually.

Pain at the incision sites after surgery is normal and should be expected. This
pain should eventually go away and should be easily controlled with oral pain me
dication that is prescribed upon discharge from the hospital.

Because the XLIF surgery only splits muscles (like an ALIF) but does not cut mus
cles (like aPLIF), many patients are able to get up and walk around the night af
ter they have had surgery.