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XLIF for Lumbar Pain Syndromes
Jonathan A. Hyde, MD
South Florida Spine Institute
Miami Beach, FL
Extreme lumbar interbody fusion (XLIF) is a relatively new approach for the surgical treatment of lumbar degenerative conditions. It is a minimally invasive approach allowing the surgeon to realign and stabilize motion segments from the first lumbar to the fifth lumbar level. The approach affords safe, reproducable access to the front (anterior) portions of the spine without need for the dissection of the major abdominal blood vessels. There is relatively low blood loss and surgical wound morbidity due to the small 1 ½ inch incision, obviating large dissection planes and retraction.
This approach was developed by Dr. Luis Pimenta from San Paolo, Brazil. It is based upon a development of a tissue plane accessed from the flank (right or left side) that gives direct access to the disc space requiring surgery. The major structure encountered in this approach is the psoas muscle, which is split in its fibers and not cut. There are some nerve structures located in association with the psoas, which are avoided with the use of computerized neurologic monitoring systems. After the disc is excised, a cage with biologic fusion material is inserted for stability to allow the fusion to occur.
 
The procedure is indicated for most pathologies encountered in the lumbar spine. Conditions such as degenerative disc disease, spondylolisthesis (instability), spinal stenosis, and degenerative scoliosis are routinely treated with XLIF. It is a major advancement in treating post surgical instabilities, often not requiring reopening the prior back wound to perform a new laminectomy or to replace spinal hardware. With advanced experience, surgeons can treat severe fractures, tumors, and infections with the technique. A variation of the surgery allows similar access to the thoracic spine without a major thoracotomy (an opening of the chest, requiring lung deflation).
 
The experience reported by surgeons has been quite promising. The hospital length of stay is often only 1-2 days, whereas previous operations (open anterior lumbar fusion) that try to achieve the same goal have a typical hospitalization of up to one week. The majority of patients walk unassisted the same day of the surgery. It is rare that patients undergoing routine XLIF surgery require blood transfusions, considering my reported experience (including complex cases) has an average blood loss of about 65 cc. The most common reported side effect of the procedure is a dysthesia (abnormal sensation) reported in the thigh corresponding to the side of the surgical approach, which dissipates in most patients by 6-8 weeks postoperative.
Future application of this approach is towards motion preservation in the properly indicated patient. A lateral total disc replacement (TDR) has been under development, and initial implants have been performed outside of the US. A FDA approved IDE study is slated to be considered in the 4th quarter of 2008 to investigate the application of this easily revisable TDR device.
Recommended website: www.lateralaccess.org (Society of Lateral Access Surgeons - SOLAS)
This article represents the author's opinions and not those of the website operator. We are not offering individualized diagnoses or medical advice, just general medical information
Published on site 7/21/08 |