Degenerative Disc Disease
Degenerative disc disease (DDD) is a loss of the functional integrity of the disc, which can lead to painful micromotion, disc collapse, and progressive degenerative pathologies, including disc prolapse or herniation, degenerative spondylolisthesis, degenerative scoliosis, degenerative lateral listhesis, and degenerative stenosis.
Value of XLIF
The XLIF procedure was created to be a safe and reproducible, minimally disruptive surgical technique for spine conditions such as DDD. In DDD, anterior column correction can be accomplished using the XLIF procedure, providing stability, indirect decompression, and sagittal and coronal alignment.
For a 65-year-old female with degenerative disc disease and resulting mechanical low back pain and radiculopathy confirmed by positive discogram at L2-L3, surgical treatment was achieved through single-approach lateral exposure and fixation with XLIF DecadeTM plate. Operative time was 47 minutes, estimated blood loss was less than 50cc, and the patient was discharged after less than 24 hours in the hospital.
Advanced DDD with Resultant Degenerative Spondylolisthesis
Vertebral body displacement associated with advanced degenerative disc disease with resultant spondylolisthesis can lead to central, sub-articular, and foraminal stenosis. Traditionally when treating degenerative spondylolisthesis, the surgical goals are to decompress the nerves, stabilize the spine, stop painful motion, and obtain a fusion across the unstable level. Some potential issues when treating degenerative spondylolisthesis from the traditional posterior approach include abnormal sagittal alignment following laminectomy with in situ posterior fusion, limited reduction ability, small interbody implant options that may lead to subsidence, and disruption of posterior musculature and facets.
Value of XLIF
The XLIF procedure was created to be a safe and reproducible, minimally disruptive surgical technique for spine conditions. Ligamentotaxis is accomplished through a lateral approach with the placement of a large interbody implant, resulting in restoration of disc height, correction of alignment, and indirect decompression. XLIF has been shown to provide indirect decompression of central, sub-articular, and foraminal stenosis. View Source
1) Oliveira L, Marchi L, Continho E, Pimenta L. A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. SPINE. 2010;35(265):S331-S337.
Lordotic implants also enable restoration of sagittal alignment.
For a 57-year-old female with advanced DDD with resultant Grade I degenerative spondylolisthesis and central and foraminal stenosis, XLIF was used to reduce the spondylolisthesis, restore sagittal alignment, and achieve indirect decompression.
Advanced DDD with Resultant Degenerative Scoliosis
Degenerative scoliosis is primarily a result of advanced degeneration of the disc with asymmetric disc collapse, vertebral body wedging, and loss of facet joint competence. Traditionally, there have been many challenges in treating coronal and sagittal imbalances, the loss of lordosis, anterolisthesis, and rotary listhesis, as well as foraminal stenosis.
Value of XLIF
The XLIF procedure was created to be a safe and reproducible, minimally disruptive surgical technique for spine conditions. Ligamentotaxis is accomplished with the placement of a large interbody implant, resulting in restoration of disc height, correction of alignment (sagittal, coronal, and axial planes), and indirect decompression. In particular, focal foraminal stenosis from coronal malalignment can be alleviated with an XLIF interbody implant.
For a 65-year-old female with advanced DDD and resultant degenerative scoliosis and central and foraminal stenosis, XLIF at L3-L5 resulted in restoration of disc height, correction of sagittal, coronal, and axial alignment, and indirect decompression, while minimizing the morbidity associated with traditional approaches.
Adjacent Segment Degenerative Disc Disease
Adjacent segment disease describes new symptoms caused by the disc degeneration of a mobile segment directly above or below a previous spinal fusion. Traditionally, it has been a challenge to navigate through scar tissue from the prior surgery to address the new symptomatic segment. Other potential issues when treating adjacent segment degenerative disc disease have included removal or extension of existing posterior instrumentation, direct decompression following a previous posterior surgery, restoration of sagittal balance, and common occurrences of nerve injuries, dural tears, and vascular injuries.
Value of XLIF
The XLIF procedure was created to be a safe and reproducible, minimally disruptive surgical technique for spine conditions. The lateral approach provides access through virgin anatomy, avoiding scar tissue and helping to mitigate risk of nerve or vascular injuries. In addition, this technique eliminates the need to remove
An 81-year-old female who underwent L3-S1 fusion nine years prior was experiencing mechanical lower back pain. Degenerative disc disease adjacent to a prior fusion was confirmed by MRI. She demonstrated low-grade slip in flexion/extension. L2-L3 XLIF with XLIF DecadeTM plate fixation allowed access through virgin anatomy and resulted in restoration of disc height, correction of sagittal alignment, and indirect decompression, while minimizing the morbidity associated with traditional approaches. The patient was discharged from the hospital the same day as her surgery.
Partial or complete resection of a vertebral body—a corpectomy procedure—is usually performed to treat a spinal fracture or tumor. Traditional thoracic corpectomy procedures require a thoracotomy—resection of a rib, deflation of the ipsilateral lung, and insertion of a chest tube upon close to remove air and fluid from the chest. These surgical requirements contribute to increased postoperative pain and pulmonary complications such as atelectasis and pneumonia.
Value of XLIF
The XLIF procedure was created to be a safe and reproducible, minimally disruptive surgical technique for spine conditions. For corpectomy, XLIF offers conventional surgery through a less disruptive approach, minimized exposure-related patient morbidity, and seamlessly integrated instrument, implant, and fixation platforms.
A 17-year-old male was involved in a snowboarding accident that resulted in an L1 fracture with complete motor deficit. The patient was treated with XLIF corpectomy of the L1 vertebral body and anterior plating fixation through the same lateral approach within two hours of injury. The patient regained motor function and at 12 months postoperatively returned to activity as a collegiate athlete.
DDD with Sagittal Plane Deformity
Sagittal plane deformity resulting from advanced degenerative disc disease is an increasingly recognized cause of pain and disability in adult patients. Several studies show that adequate restoration of sagittal plane alignment, in addition to spinopelvic balance, is essential for desirable outcomes in adult deformity. Traditional methods used to correct fixed sagittal deformities include posterior-based osteotomies, such as Smith-Petersen osteotomies (SPO) and three-column resections, such as pedicle subtraction osteotomies (PSO) and vertebral column resections (VCR). However, these techniques are associated with significant morbidity, including prolonged operative times, neurological complications, and a high volume of blood loss. View Source
1) Akbarnia BA, et al. Anterior Column Realignment (ACR) for Focal Kyphotic Spinal Deformity Using a Lateral Transpsoas Interbody Approach and ALL Release. Journal of Spinal Disorders & Techniques. Accepted for publication.
Value of XLIF
The XLIF procedure was created to be a safe and reproducible, minimally disruptive surgical technique for spine conditions. XLIF Anterior Column Realignment (ACR™) allows surgeons to access the anterior column of the thoracic and lumbar spine from the lateral position to divide the anterior longitudinal ligament (ALL) and provide anterior column fusion using hyperlordotic implants in adult patients with deformities secondary to advanced degenerative disc disease. This technique provides an alternative method to traditional open procedures and allows surgeons to address sagittal imbalance from the anterior column, while adhering to standard deformity principles.
For a 77-year-old male patient with advanced degenerative disc disease with resultant scoliosis and sagittal imbalance, XLIF ACR resulted in restoration of sagittal balance, correction of alignment, indirect decompression, and restoration of disc height, while minimizing the extent of posterior osteotomies and associated morbidity.