What is Lateral Lumbar Interbody Fusion?
Lateral Lumbar Interbody Fusion, which is also known as Extreme Lateral Interbody Fusion (XLIF), is a newer fusion technique for the relief of persistent lumbar region, or lower back, pain. XLIF is performed from the side of the body rather than the back. Interbody fusion refers to the removal of an interverterbal disc, which is replaced with a bone spacer, and the adjacent vertebrae are fused together.
XLIF can be used to treat nerve compression, disc space collapse, spondylothesis and other painful lower back conditions. After obtaining images of the spine with MRI and CT scans, a physician can determine just what type of implant would be best suited to correct the problem.
This surgery is different from other forms of fusion because it uses a side approach. Approaches from the posterior, or back, necessitate the disturbance of muscles, nerves, blood vessels and ligaments in the back. Approaches from the anterior, or front, of the body pass through the abdominal muscles and come near the aorta and other vascular structures and urinary organs. By approaching from the side of the body, the spine can be reached with a minimal amount of risk and tissue damage. In addition, the side approach to the spine provides access to the damaged disc without the need for removing vertebral bone. Since the XLIF process is minimally invasive to the muscles and tissues at the site, complications are generally fewer and recovery is faster and easier than with other fusion procedures. However, it can only be performed on vertebrae that can be reached from the side and no more than two levels can generally be treated.
The XLIF Procedure
The XLIF procedure is performed under general anesthesia with the patient lying on his or her side on an operating table. The treatment site is cleansed with an antiseptic and the surgeon makes two very small incisions in the side of the body near the affected area. A probe is inserted to identify the location of nerve tissue in order to avoid it and reduce the risk of nerve damage. Dilators are used to separate and gently retract the muscles. An imaging device will ensure that the precise vertebrae are targeted. Next, the injured disc, bone spurs or any other nearby debris are then taken out. This restores room for the nerves that have been compressed, relieving pain and symptoms in the lower back and legs.
To fill the space that has been created, a bone graft or bone morphogenetic proteins are then attached in the open disc area along with any necessary instrumentation to promote stability in the spine. Dr. Lipani carefully inserts the spacer that contains the graft material, avoiding the spinal cord and nerves present nearby. In addition, metal plates, rods and screws are attached as needed to hold the spinal bones in place while fusion is occurring.
Bone morphogenetic protein (BMP) is an FDA-approved treatment used in conjunction with spinal fusion surgery to stimulate bone growth within the treated area and achieve optimal results without the need for a bone graft. However, bone grafts taken from another part of the patient’s own body or obtained from donor bone are also highly successful.
Once complete, imaging is used again to confirm the placement of the spacer and instrumentation. The surgeon can then close up the incisions with sutures. The XLIF surgery may vary in length, generally lasting between one and three hours, depending on the extent of the damage in the spine.
Recovery from an XLIF Procedure
After undergoing an XLIF procedure, patients will typically remain in the hospital for an overnight stay. A physical therapy regimen should be started soon after, as it is beneficial for regaining strength and full mobility. Certain activities may be restricted, including lifting objects, twisting the midsection and bending at the waist. Many patients can return to work two to three weeks following the procedure if their employment does not require strenuous exertion. After three months, patients may be cleared to resume some sports and more rigorous activities, but this will depend on the number of vertebrae fused during the surgery as well as each patient’s individual healing process.
Risks of an XLIF Procedure
While XLIF is considered a safe procedure, it is still a form of spinal surgery and it therefore carries some risks. While uncommon, the complications it is associated with include infection, muscle weakness, pain, hardware failure and graft failure.