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XLIF/DLIF Lateral Fusion

The XLIF is a type of interbody fusion, in which the disc in the front of the spine is removed and replaced with an implant containing a bone graft in order for the 2 vertebrae to fuse together through the disc space.

During an eXtreme Lateral Interbody Fusion (XLIF) procedure, the surgeon accesses the intervertebral disc space and fuses the lumbar spine using a surgical approach from the side rather than from the front or the back.

The XLIF is one of a number of spinal fusion options that a surgeon may recommend to treat specific types of lumbar spinal disorders, such as:

• lumbar stenosis
• lumbar herniated disc
• scoliosis
• spondylolisthesis
• lumbar degenerative disc disease

The XLIF procedure is termed as a minimally invasive procedure, which means that instead of a traditional, larger single incision, the procedure is performed through one or more small incisions and an instrument known as a retractor is used to spread the tissues so that the surgeon can see the spine.

The XLIF procedure was designed to treat disorders of the spine with the least amount of tissue disruption possible. The following series of steps are performed to complete an XLIF spinal fusion:

• the patient will be positioned lying on his or her side
• 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

• the surgeon will make a small incision in the low back region of the trunk and use his or her finger to push away the peritoneum 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 through a muscle known as the psoas muscle
• a retractor tool is put into place to give the surgeon direct access to the spine
• the surgeon performs a standard discectomy to remove the disc
• the surgeon inserts the implant through the same incision from the side
• the surgeon will take an X-ray to make sure that the spacer is in the right position

The surgeon may also decide to put in an additional implant, such as screws, plates or rods for added spine support.

XLIF 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

Like any other surgical procedure, the XLIF has certain potential risks and complications associated with it. Possible risks and complications include but are not limited to:

• deep vein thrombosis
• failure to fuse
• further progression of existing spinal disease
• infection
• muscle weakness
• neurologic injury
• persistent pain at the site of bone graft harvest (in the hip)
• persistent pain/continued pain after surgery
• pneumonia
• stroke
• urinary tract infection
• vascular injury

Discuss all potential risks of the XLIF procedure with your physician prior to surgery.

Here is an example of a patient who underwent a DLIF procedure. In her late eighties, she suffered with back and bilateral leg pain for many years. She was unable to stand for 5 minutes due to pain. She had a spondylolisthesis at L4-L5 that was treated with DLIF, pedicle screws, and decompression. At last follow-up 2 years after the surgery, the patient was able to stand for 20-30 minutes and her pain was reduced to half of the pre-op level.

Preoperative Lateral X-Ray
Pre-op lateral x-ray showing spondylolisthesis at L4-L5 (slipped vertebrae of L4 forward on L5) causing stenosis.

Postoperative Lateral X-Ray
Post-op lateral x-ray showing PEEK spacer increased disc height, restored lordosis (normal curvature) and reduced slip of L4 on L5, thereby relieving stenosis. Additionally, pedicle screws provide stability to increase fusion success.