Minimally Invasive Lateral Lumbar Fusion (XLIF)
The lateral lumbar interbody fusion (XLIF) is a minimally invasive fusion procedure that is utilized when the stenosis is caused by or associated with scoliosis, instability (spondylolisthesis) or severe disc degeneration. This minimally invasive procedure begins with a small incision being placed on each side of the spine. Then the intervertebral disc is removed and a plastic spacer is inserted between the vertebral bodies to relieve the pressure on the nerves. This procedure can take 30 to 120 minutes depending on the extent of spinal stenosis.
Most patients stay overnight and go home the following day. For patients with severe scoliosis, this is also an excellent method to achieve deformity correction without the extensive pain, operative time and blood loss associated with traditional scoliosis surgery. For patients with severe scoliosis and others with osteoporotic bone, screws may also need to be placed to achieve absolute stabilization. Screws are placed in a minimally invasive fashion through 1-cm incisions on the back. Whether or not a patient needs screws is dependent on an individual’s bone quality, pathology and other medical conditions that will be discussed prior to surgery.
The patient in the above radiograph is a 62 year old female who underwent a posterior fusion 12 years ago. She developed stenosis with a degenerative disc at the level above the fusion. The radiograph on the left shows the flattened disc space on the radiograph; on the right you can note how the XLIF spacer restored the disc height after the XLIF procedure. The surgery took 30 minutes and she went home the next day with a minimal amount of “soreness” at the incision site. She had immediate relief from leg pain, numbness and tingling.
This 72 year old woman underwent a minimally invasive fusion (utilizing the XLIF procedure) for lumbar spinal stenosis and scoliosis. She had one small incision on the side for the XLIF procedure and a second procedure requiring several very small incisions on the back for each screw. She was in the hospital for 4 days before going home (XLIF on Monday and the screws on Wednesday before being discharged on Friday). She lost a minimal amount of blood and did not require a blood transfusion. She was walking independently the day after each procedure. The radiograph on the left shows her scoliosis before the surgery and the radiograph on the right demonstrates her curve after surgery.