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Extreme Lateral Interbody Fusion (XLIF)

Extreme lateral interbody fusion (XLIF) is a relatively new approach to lumbar (low back) spinal fusion surgery.

XLIF uses a lateral (from the side) incision in order to place a large structural cage in the spine. This structural cage restores normal disc space between the bones and provides indirect decompression of the spinal canal and nerve roots.

XLIF can be performed as a standalone procedure, or along with the placing of a structural plate or screws, inserted through a separate incision in the back.

For some patients, this can be an alternative to ALIF surgery.

Having Extreme Lateral Interbody Fusion (XLIF) Surgery

When having XLIF surgery, you will lay on your side while under general anesthesia and your surgeon will make a one- to two-inch, lateral (from the side) incision between the ribs and the hip.

The surgeon will then cut through oblique muscles and move the abdominal contents off to the side in order to gain access to the psoas muscle and the lumbar spine.

The surgeon then inserts small dilators through the psoas muscle, which are stimulated with an electronic current in order to identify and avoid nerves during surgery.

A retractor is then placed directly over the disc space to hold the lumbar spinal nerves back and give the surgeon a clear view of the disc space from the side.

The surgeon is then easily able to remove the damaged disc(s) from the disc space and cartilage from the end plates.

After cleaning the disc space, the surgeon then inserts a trial cage to ensure it is correctly sized and properly positioned in the spine.

Once the appropriately sized cage is selected, it is inserted into the empty disc space using X-ray fluoroscopy.

Once the incision has been made, the XLIF procedure typically requires 20-30 minutes of operative time per level of structural cage that is placed.

Blood loss is minimal. Because there is less muscle disruption, patients tend to report less pain in our experience.

How XLIF Works

XLIF provides indirect decompression to nerve roots by restoring height that is lost with aging and arthritis.

By providing access to the front of the spine, it allows surgeons to place larger cages that both reestablish lost height more effectively while regaining normal lordosis (curve) that is lost over time.

Lastly, in patients with instability or spondylolisthesis, it provides immediate stability, and, in some cases, can reduce the slip.

Benefits of Extreme Lateral Interbody Fusion (XLIF) Surgery

XLIF offers several benefits, including:

  • By using a direct lateral approach, the surgeon does not have to avoid major blood vessels, the spinal cord or nerve roots.
  • The lateral approach allows the surgeon to deliver a much more structurally sound cage.
  • The XLIF procedure minimizes the amount of additional work that needs to take place during the traditional posterior (from the back) approach.

Recovering from XLIF Surgery

Recovery from XLIF as a standalone procedure is quite rapid.

Most patients leave the hospital within 24 hours after surgery. When XLIF is performed as a multi-level surgery, recovery can take longer.

Following XLIF surgery, people may experience some secondary pain radiating from the back down into the thigh or groin area, caused by minor trauma to the muscles during surgery.

Patients can also experience some numbness and tingling in the thigh area following surgery. These symptoms tend to improve rapidly and disappear within a month. Pain is typically very limited and is gone quickly.

Prognosis for patients undergoing XLIF surgery is excellent.

Patients have a greater than 95 percent successful fusion rate with XLIF surgery and decreased rates of infection when compared to traditional spinal fusion approaches.

Generally, patients wear a back brace for a month after surgery, start physical therapy by month 2, and return to their normal activity by 6 months.

In the first month, we ask you to avoid excessive bending, twisting, or heavy lifting greater than 10lbs.

We do encourage you to walk as much as possible, and avoid being sedentary or lying down for excess periods outside of sleeping at night.

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