Extreme Lateral Interbody Fusion (XLIF)
A Minimally Invasive Approach for Degenerative Spinal Conditions
The XLIF, short for eXtreme Lateral Interbody Fusion, is an approach to spinal fusion in which the surgeon accesses the intervertebral disc space and fuses the lumbar spine (low back) using a surgical approach from the side (lateral) rather than from the front (anterior) or the back (posterior). It is one of a few spinal fusion options that a surgeon may recommend to treat specific types of lumbar spinal disorders, including lumbar degenerative disc disease, spondylolisthesis, scoliosis and deformity and some recurrent lumbar disc herniations and various types of lumbar stenosis. The XLIF procedure was developed and subsequently improved, to overcome some of the drawbacks and disadvantages of other surgical approaches to spinal fusion, such as those with traditional open spine surgical techniques.
To help you understand the XLIF procedure, the indications, contraindications, benefits, care, and overall procedure are briefly described below.
Not everyone is a candidate for minimally invasive spine surgery, once conservative (non-operative) treatments have failed, you should consult a surgeon to see if you are an appropriate candidate for XLIF.
Indications for XLIF
XLIF might be recommended if you have the following conditions:
- Degenerative disc problems with spine instability
- An intervertebral fusion between any two or more vertebrae in your L1 – L5 is necessary
- Recurrent disc herniation
- Instability after a previous non-fusion surgery
- Posterior pseudarthrosis (failed previous fusion surgery)
- Slipping of one vertebra over another
- Degenerative scoliosis (sideways curve of spine)
Contraindications for XLIF
XLIF may not be suitable for you if any of the following applies to your condition:
- Deformities of the spine greater than 30 degrees rotation
- Abscess or scaring on the site from other surgeries
- Significant co-morbidities
- Systemic infection
- Symptomatic level at L5-S1 (base of the spine)
- Need for direct nerve decompression using the same approach
The conditions listed above are just some of the contraindications to XLIF. Still, it is recommended to seek a physician’s advice and discretion to determine if you are or aren’ta good candidate for the procedure.
Benefits of XLIF
Minimally invasive spine surgeries, including XLIF have many benefits including the following:
- Minimal scarring and Reduced Blood Loss – XLIF is a minimally invasive procedure: it involves dilatation of the tissue which results in less trauma to the tissues
- Reduced Operative Time – Unlike traditional surgeries, XLIF takes as short as 1 hour to perform, reducing the period of anesthesia time
- Shorter Hospital Stay Post-Surgery – Patients who have XLIF generally stay 1-2 days at the hospital, as compared to several days of hospitalization after open (traditional) surgeries
- Less Post-Operative Pain – XLIF does not require large opening and incisions which means that there is less trauma to the muscles, ligaments, and bones. Less trauma to these parts results in less post-operative pain and discomfort
- Rapid Return to Normal Activities – Recovery with XLIF typically takes only several weeks, compared to several months of recovery time and healing associated with other forms of surgical approaches
Weeks to Days Before Surgery
As with any surgical procedure, make sure that all your questions are answered before XLIF. You should also inform the healthcare staff at the hospital about medications that you are currently taking, any health problems you have, and general concerns about the procedure.
Before deciding to undergo XLIF, your surgeon or primary physician will review your condition and discuss all the treatment options aside from XLIF. After assessment and thorough examination, your doctor will explain its advantages and disadvantages and guide you in the best decision for your personalized treatment plan.
Few Days Before Surgery
Days before surgery, you will be prepared with instructions about the operation, what to expect after, possible course of action after the procedure including diet, therapy, and other post-operative care.
Night Before to the Day of Surgery
You may be advised to not eat or drink 8 to 12 hours or after midnight before your surgery. An empty stomach will reduce the chances of complications such as aspiration or food or fluid going to the lungs from the stomach.
During the day of the surgery, pre-operative medications might be given by the nurse or your physician. The healthcare staff will then assist you to the operating room and anesthesia will be given, and you will be positioned on your side for the surgery.
The Procedure: How is XLIF Performed
XLIF involves the use of a minimally invasive technique wherein the spine is approached through the side (lateral) of the body. During the procedure, you will be positioned on your side. Using X-ray, your surgeon will locate and mark off the affected region. Next, your skin will be marked at the site where two small incisions will be made.
Through the small incisions, your surgeon will fuse vertebrae together, with the use of sterile and specialized surgical instruments. Fusing two or more vertebrae requires removal of the ‘cushion’ also called intervertebral disc. To mimic the function of the intervertebral disc, an intervertebral spacer will be implanted, to maintain the distance between the vertebrae. The space between the fused discs will also be packed with bone-forming cells to finish the fusion of the joints.
XLIF does not involve cutting or dissection of the back muscles, tissues, bones, and nerves. Additionally, it does not allow exposure of the abdominal contents nor removal of ligaments. With XLIF, there are fewer chances of having a vascular injury as compared to other surgical fusion procedures.
Immediately after surgery
After XLIF, you will wake up in a recovery room where you will be monitored. Vital signs will be taken from time to time or as necessary. Your immediate condition after surgery will be carefully watched. Once your physician or surgeon verifies that you are doing well, you will be returned to your hospital room.
Few Days After Surgery
Your incision site will be sore after surgery; this is normal since you underwent surgery. Your healthcare staff (nurses or nursing assistants) will check you, especially your vital signs to monitor that you are stable and that there are no complications post surgery.
Most patients are discharged 1 to 2 days after surgery, but since post-op conditions vary from case to case, your physician will determine the best post-operative care for you. Your stay at the hospital may depend on your condition after the surgery, as well as your overall comfort and other health problems or concerns you might have.
Ten Days to Weeks After Surgery
In general, XLIF patients are requested for a follow-up check-up in a week or 10 days to few weeks post surgery. If you have concerns or problems at home during the first week after surgery, be sure to contact your physician immediately. For questions that may arise that doesn’t warrant immediate action from your physician, write it down and ask your doctor during the next appointments.
Months to Years After Surgery
Follow up visits may be scheduled at various intervals, depending on the discretion of your physician. It may last up to two years or more to assess your recovery and the XLIF progress.
The Extreme Lateral Interbody Fusion (XLIF) might be a viable option for you. To find out more about this minimally invasive approach to spine surgery, please contact us, Saint Camillus Medical Center, at 817-519-3700, or visit us at 1612 Hurst Town Center Drive, Hurst, TX 76054.
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- “Introduction to Extreme Lateral Interbody Fusion.” Home | NuVasive. NuVasive, Inc., Web. <http://www.nuvasive.com/wp-content/uploads/2017/03/XLIF-Patient-Education-Brochure-US.pdf>.
- “Fact Sheet: eXtreme Lateral Interbody Fusion (XLIF®).” Midwest Orthopaedics at Rush | Top US & Chicago Orthopedic Doctors. NuVasive, Inc., Web. <http://www.rushortho.com/sites/default/files/images/PDFs/XLIF_Fact_Sheet1.pdf>.
- Billinghurst, Jason, and Behrooz Akbarniab. “Extreme lateral interbody fusion – XLIF.” Lippincott Williams & Wilkins., Web. <http://pdfs.semanticscholar.org/fbc1/ca32b9e7cfc0ff8cb8fcf1e7a91f3e1b944b.pdf>.
- ” Extreme Lateral Interbody Fusion (XLIF) | Health Resources | Wellness Library | UPMC Pinnacle.” UPMC Pinnacle: A Top-Rated Healthcare System in Central PA. <http://www.pinnaclehealth.org/wellness-library/blog-and-staywell/health-resources/article/20457>.
- “Why Can’t I Eat or Drink the Night Before Surgery? | Inside Mount Sinai.” Inside Mount Sinai | Latest Health Information, Patient Stories, & Research. <http://inside.mountsinai.org/blog/why-cant-i-eat-or-drink-the-night-before-surgery/>.