Lateral Interbody Fusion (XLIF) Surgery
What is an XLIF/DLIF?
An XLIF or Extreme Lateral Interbody Fusion (XLIF) procedure is a minimally invasive spine operation. Dr. Ghasem approaches the selected lumbar spine level(s) from a small incision through the side flank underneath the rib cage. The levels are targeted through fluoroscopic visualization. The abdominal contents are safely mobilized and retracted out of the way to provide wide visual access to the desired disc. The injured disc is then replaced with a structurally supportive spacer. This spacer acts to stabilize the spine as well as recreate the natural height and curvature of the spine.
Do I qualify as an XLIF/DLIF candidate?
Patients experiencing intractable pain as a result of nerve compression or degenerative disc disease at an isolated level that have failed conservative management are possible candidates. Additional indications include:
- Spondylolisthesis (Unstable vertebral slips
- Lumbar Radiculopathy (Radiating leg pain)
- Thoracic Myelopathy
- Spinal Deformity or Scoliosis
- Nonunion (Previously non-healed spinal fusions)
- Spinal Disc Space Infections
Patients who have had extensive prior abdominal operations or radiation, may not qualify as candidates. Additional anatomic factors producing variability including pelvic osseous anatomy, blood vessel positioning, and native lumbar plexus nerve location can preclude some patients from being candidates for this operation. Careful review during consultation with Dr. Ghasem can clear up whether or not you qualify.
XLIF/DLIF Procedure in Detail
The procedure is performed under general anesthesia with the patient positioned on their side after being safely and securely fastened to the operative table. The table is oriented so that the ribs as well as the pelvis are out of the way and the soft tissues are placed under ideal tension conditions. Soft padding is then used to support the patient during the entirety of the procedure.
The torso is prepped with disinfectants and a small approach through the side is performed by safely moving superficial muscles out of the surgical field.
As previously stated, the abdominal contents are swept carefully to the side within the peritoneal sac and protected with retractors.
We then use muscle sparing techniques to go through natural planes within the muscle or just in front of the muscle to reach the spine.
All of this is being done with continuous neurologic monitoring of the peripheral nerves to ensure an added degree of safety and patient protection.
The targeted disc is then confirmed under intraoperative imaging and a safe zone is created with a tubular retractor. The disc is then methodically removed.
An optimal trial implant is selected after the disc space is prepared for implant delivery and the final interbody spacer is inserted with integrated bone promoting biologics.
The spacer is then fixated into the vertebral bone and each layer of tissue is repaired in its native position.
Depending on its desired purpose, an XLIF/DLIF may be able to suffice without any additional surgery.
In certain situations, the XLIF/DLIF operation is then augmented with posterior instrumentation to further enhance fusion rates or an open decompression for improved neural function recovery.
XLIF/DLIF Post Op Recovery
Post operative functional recovery and the need for an acute rehabilitation facility is in large part dependent on the baseline pre operative function. The vast majority of patients are walking the same day after surgery with expert physical and occupational therapists. Time to return to work varies depending on the job description but on average is between 2- 6 weeks. Post operative restrictions with gradual return to daily activities will be discussed in detail before the operation and should be adhered to very closely to avoid adverse events. Restrictions are completely lifted once a solid fusion has been obtained.