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Orthopedics

XLIF is a New Method to Attain Lumbar Fusion

XLIF to Attain Lumbar FusionRichard Brower, M.D., Chief of Orthopaedic Spine Service, Orthopaedic Focus Winter 2011

Surgical indications remain the most important factor in predicting outcomes of lumbar fusion. Degenerative or lytic spondylolisthesis remain the best documented reasons to perform lumbar fusion, with degenerative disc disease continuing to be a controversial indication for surgery.

The patient with repeated herniations (>2) at the same level also has a clear indication for surgical fusion. Patients with emotional disturbance and secondary gain issues (i.e., active workers’ compensation claim) are patients in whom surgical intervention should be avoided if possible.

Methods of lumbar fusion have changed significantly, especially during the past 20 years. The development of pedicle screw systems has given surgeons a much more effective way to immobilize the lumbar spine after removal of the posterior elements in order to decompress lumbar spinal stenosis.

This technology has been partially responsible for the marked increase in the number of lumbar fusions performed per year. The use of instrumentation has opened opportunity to directly correct the alignment of the lumbar spine to:
• Reduce spondylolisthesis
• Correct scoliosis
• Realign fractures

The technology has also allowed surgeons to try to achieve lumbar fusion while making smaller incisions and, therefore, causing less collateral damage.

XLIF® stands for extreme lateral interbody fusion. It represents a novel method for lumbar fusion. Rather than making an incision on the back, the surgeon can access the patient’s retroperitoneal space through a small incision on the patient’s side, remove the disc and place an implant with graft material to promote fusion of the lumbar disc space.

The surgical track is through the retroperitoneal space and then to dilate through the psoas muscle to access the disc space. The implant used for XLIF® reaches all the way across the disc space to the opposite side to have a wide footprint in order to decrease surface contact forces.

The technique may be combined with pedicle screw instrumentation for additional fixation in some cases.  This technique is not appropriate for the L5-S1 level and should not be used in patients with osteoporosis, without additional fixation. High-grade spondylolisthesis, high-grade spinal stenosis and high-riding iliac crests are also contraindications.

XLIF® is a technique for a select group of patients. In appropriate cases, patients may experience relief of symptoms with minimal blood loss and an overnight stay in the hospital.

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