Quick Facts
Possible Symptoms
- Leg pain, numbness, and/or weakness
- Back pain, especially with movement
- Bowel or bladder incontinence
Typical X-Ray Findings
- Spondylolisthesis, or slippage of one vertebral body upon another (MRI, CT myelogram).
- Disc and endplate changes suggesting excess “wear and tear” (MRI, CT myelogram).
- Excess movement of one vertebral body upon another when bending forward or backward (Flexion and extension x-rays)
Average Procedure Time
- 1.5 hours
Average Recovery Time
- Home in 1-2 days
- Off work 2-8 weeks, depending on duties
Postperative Limitations
- No bending, twisting, lifting, or strenuous exercises (8 weeks)
- No driving while on narcotics
The Procedure
The technique for extreme lateral lumbar interbody fusion was developed in the late nineties, and has seen widespread use since then. The procedure involves placing a cage from a lateral, or side, approach.
An approximately 1 inch incision is typically made in the left flank, and a specialized retractor is inserted and and “docked” onto the side of the vertebral body. A large portion of the disk is removed, and a cage filled with bone graft is placed. Occasionally screws and plates are used to secure the cage in place. In cases of severe instability, the XLIF is followed by a posterolateral lumbar fusion and minimally invasive instrumentation with screws and rods placed from behind.
The principal advantage of an XLIF is that it allows for removal of almost all of the intervertebral disk and placement of a large cage that can hold more bone graft, both of which increase the chances of successful fusion. Unlike an ALIF, however, retraction of critical abdominal structures is not necessary. XLIFs cannot be performed at the L5S1 level, or in situations where nerves and mucle impede the exposure.