If your healthcare provider has indicated you for the minimally disruptive eXtreme Lateral Interbody Fusion (XLIF) procedure, you may have questions about what the procedure entails. We’ve broken the procedure down into three parts, to help you better understand what happens during an XLIF procedure:
1) Approaching the Spine
After you are positioned on your side and draped, an x-ray is taken of your spine to show the location of the operative disc space. The skin is marked at this location to indicate the site of the side incision. A separate small incision will first be made toward your back. The surgeon will use his or her finger through this incision to feel the space in your side through which the instruments will pass. The finger will also guide the tubular dilators into position within this space. As the tubes are advanced through the muscle on the side of the vertebrae (psoas muscle), x-ray pictures and NVM5® nerve monitoring help to guide them to the appropriate spot on the spine and away from nearby nerves. Once the tubes are in place, a tissue retractor (called the MaXcess® retractor) is advanced over them, locked to the surgical table, and held open to provide lighted visibility and instrument access to the disc space.
2) Intervertebral Disc Removal and Preparation
With the intervertebral disc now visible and accessible, the surgeon prepares the disc space for fusion by making a hole in the outer annulus, removing most of the nucleus and the annulus on the opposite side (but leaving the annulus in the front and back), and removing the cartilage from the ends of the vertebrae to reveal the bony surface beneath. Several x-rays may be taken during the disc removal to allow for adequate preparation.
3) Intervertebral Stabilization
With the disc space prepared, the surgeon then places a large stabilizing implant into the empty space to restore the proper disc height and support the loads put on that spinal segment. Once the intervertebral implant is in position, supplemental fixation is added for further stabilization in the form of a plate or screw/rod system. The retractor is then removed and final confirmation x-rays are taken to document spinal alignment. The small skin incisions are closed with a few stitches and a bandage.
If the supplemental fixation is placed from behind (instead of from the side), the surgeon would then move you to a face-down position to perform a second procedure from the back.
Watch the XLIF Patient Animation to learn more about the procedure and see it step-by-step.
Keep in mind that all surgery presents risks and complications that are important to discuss with your physician prior to your surgery. Listening to your physician’s guidance, both before and after surgery, will help to ensure the best possible outcome from your procedure. Potential risks following XLIF surgery include: problems with anesthesia, infection, nerve damage, problems with the graft or hardware, and ongoing pain. This is not intended to be a complete list of the possible complications, so be sure to discuss all potential risks with your healthcare provider.
You can also talk with a patient who’s had the XLIF procedure. The Better Way Back has a network of Patient Ambassadors who talk to patients considering the XLIF procedure. These Patient Ambassadors share their first-hand experiences with the XLIF procedure and help answer questions about what to expect after surgery. If you’re interested in being paired with a Patient Ambassador, fill out the Join Our Community form and we’ll connect you with one.
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