XLIF - Extreme Lateral Interbody Fusion
Extreme lateral interbody fusion (XLIF) is a minimally-invasive surgery that involves the fusing of two degenerative spinal vertebrae. The procedure is conducted to relieve painful motion in the back caused by spinal disorders.
Spinal problems occur primarily between vertebrae, where they are packed with a cushioning material called intervertebral disc. Over the years, the discs undergo wear and tear, allowing the vertebrae to painfully rub against each other when we move, and they degenerate.
Fusing of degenerated vertebrae maintains the optimal disc space between them, aligns and stabilizes the spine, and protects the spinal cord and nerves from further damage.
XLIF is considered when the patient does not respond well to pain killers, physical therapy and steroid injections. It is indicated for leg and back pain that are caused by any of the lumbar or lower spine disorders listed below.
- Degenerative disc disease (damaged discs between two vertebrae)
- Degenerative scoliosis (sideways curve of spine)
- Degenerative spondylolisthesis (one vertebra moves away from the normal spine alignment)
- Recurring disc herniation (ruptured disc)
- Posterior pseudoarthrosis (previous failed fusion surgery)
- Post-laminectomy syndrome (spinal instability following non-fusion surgery)
- Adjacent level syndrome (condition that occurs next to previous fusion surgery)
XLIF may not be an option for the following conditions:
- Degenerative spondylolisthesis of greater than grade 2
- Presence of scarring behind the abdominal cavity, on either side of the spine as a result of previous surgery or abscess
XLIF adopts a lateral approach when compared to traditional methods of spinal fusion techniques, and in doing so, spares the disruption of major back muscles, ligaments and bones. Since the procedure is done in close proximity with several important nerves in the spinal column, your surgeon will continuously monitor them with electromyography (EMG) to avoid any damage to the nerves.
The surgery takes about one hour and is performed under general anesthesia. You will be positioned onto one side. Using X-ray, your surgeon will locate and mark off the affected region. Through a small incision made in your back, your surgeon will hold back the peritoneum (outer covering of abdominal organs) and will make a second incision on your side for instruments called tubular dilators to pass through. The affected disc is then removed, and replaced with an implant filled with bone graft, which will aid in the fusion of the adjacent vertebrae. The instruments are removed and incision stitched and bandaged. Additional support with the help of plates, rods or screws may be inserted.
XLIF ensures a quick recovery and lets you return to normal activities. As this approach does not damage muscles, ideally you will be able to walk the evening of the surgery and will be discharged the next day. Following your discharge, you will be prescribed medication for pain.
Risks and complications
The surgery may be associated with infection, damage to nerves, spinal cord or blood vessels, muscle weakness and enduring pain at the site of bone graft. There are chances of the implant failing to fuse the vertebrae and a progression in the existing disease. Other conditions such as deep vein thrombosis or clotting, urinary tract infection, stroke and pneumonia may develop following the procedure.
Dr. Hiratzka serves as teaching faculty for the XLIF procedure for Nuvasive, teaching fellows, residents and practicing spine surgeons from around the country