Extreme Lateral Interbody Fusion (XLIF)

The Extreme Lateral Interbody Fusion (XLIF) is a useful procedure for a number of conditions that require fusion of the lumbar spine such as degenerative conditions, instability, and deformity of the lumbar spine. It can be performed at multiple lumbar levels although in most patients it is performed only at one or two levels. Most surgeons limit the procedure to upper and mid lumbar levels (L1-2, L2-3, L3-4) because of the risk of injury to the sensory nerves to the legs when the XLIF is performed at lower (L4-5, L5-S1) levels. While the XLIF may be performed as a single "stand alone" procedure, in most cases it is combined with a posterior decompression and/or stabilization procedure with pedicle screws and rods.

The Extreme Lateral Interbody Fusion (XLIF) can be performed through a minimally invasive or mini-open approach. The procedure is usually performed with the patient under general anesthesia. The patient is then positioned on one side. A 3-4 centimeter incision is made on the patient’s side. The abdominal muscles are split to gain access to the space behind the abdomen (retroperitoneal space). The front of the spine is identified and a series of small dilators enlarges the space until a small tubular retractor can be placed on the spine. Small nerve stimulators are used to identify and protect the nerves that travel in the psoas muscle on the front of the lumbar spine. The disc is then removed using specialized instruments. Once the disc is removed a bone graft or interbody fusion device is placed into the empty disc space. Once the interbody device is placed, the tubular retractor is removed and the small incision is repaired with stitches and a sterile dressing.