NuVasive®, Inc.
A
A

XLIF®

NuVasive

This webpage is designed to inform you about the XLIF (eXtreme Lateral Interbody Fusion) surgical procedure. It is not meant to replace any personal conversations that you might wish to have with your physician or other member of your healthcare team.

Not all the information here will apply to your individual treatment or its outcome. The information is intended to answer some of your questions and serve as a stimulus for you to ask appropriate questions about the procedure.

The Better Way Back® is a community that provides hope, support, and information for patients considering XLIF surgery for back or leg pain. For more information or to speak with a Patient Ambassador, visit www.thebetterwayback.org or call 800-745-7099.

The XLIF technique is a minimally disruptive surgical procedure performed through the side of the body. It is designed to treat a range of spinal pathologies. Using patented nerve monitoring technology, the surgeon gains lateral (side) access to the spinal column, avoiding any major nerves in the area between the incision and the column. The XLIF procedure does not require an anterior (front) or posterior (back) exposure, and thereby does not present the same risks of vascular and/or neural injury as traditional approaches.

 

 

Many spine symptoms may be treated without surgery via methods that involve medication, rest, heat, and physical therapy. It is important that you speak to your physician about the best options for you. If your symptoms do not improve with other methods, your physician may suggest spinal surgery. Surgery is reserved for those who do not gain relief from non-operative forms of treatment, patients whose symptoms are increasing or worsening, and/or patients that present with a spinal condition that indicates the need for surgery.

If you require spinal surgery, your physician may determine that the XLIF procedure is a good option for you. Some examples of pathologies (conditions) that may be ideal for the XLIF procedure include:

  • Degenerated discs and/or facet joints that cause unnatural motion and pain
  • Slippage of one vertebra over another
    (Degenerative spondylolisthesis secondary to advanced degenerative disc disease)
  • Change in the normal curvature of the spine
    (Degenerative scoliosis secondary to advanced degenerative disc disease)

Conversely, your physician may determine that an XLIF procedure is not a good option for you. It is important to discuss this with your physician in order to determine the best course of treatment for you.

Are there risks involved?

Keep in mind that all surgery presents risks and complications that are important to discuss with your surgeon 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. Please contact your physician to discuss all potential risks.

What are the potential benefits of having an XLIF procedure?

  • Reduced operative time
  • Less blood loss during surgery
  • Reduced hospital stay
  • Reduced postoperative recovery time
  • Implants designed for maximum stability of the spine
  • Smaller incision

finalxlifchart
*Weighted average results from a systematic literature review of 14 peer-reviewed, published articles and 1,575 patients treated with XLIF for degenerative (non-deformity) lumbar conditions. Data on file.
1. Villavicencio AT, Burneikiene S, Bulsara KR, et al. Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability. J Spinal Disord Tech 2006;19:92-7.
2. Lucio JC, VanConia RB, Deluzio KJ, et al.. Economics of less invasive spinal surgery: an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period. Risk Management and Healthcare Policy 2012;5,65.
3. Rihn JA, Patel R, Makda J, et al. Complications associated with single-level transforaminal lumbar interbody fusion. Spine J 2009;9(8):623-629.
4. Ozgur BM, Agarwal V, Nail E, et al. Two-year clinical and radiographic success of minimally invasive lateral transpsoas approach for the treatment of degenerative lumbar conditions. SAS J 2010;4(2):41-46.
5. Park Y & Ha JW. Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional approach. Spine 2007:32(5):537-43.

The above data represents typical outcomes of patients being treated for degenerative disc disease, spondylolisthesis, and scoliosis.

Your physician will review your condition and explain all of your treatment options, including medications, physical therapy, and other surgeries such as removal of a diseased disc, fusion, etc.

Once you have been admitted to the hospital, you will be taken to a pre-op room and prepared for surgery. This may include instruction about the surgery, cleansing of your surgical site, as well as instruction about the postoperative period.

Your surgeon will make a small incision on the lateral (side) of your body. Dilators will be used to direct the path to the affected disc space while monitoring the local nerves. Once the safest path has been determined, a retractor will be utilized to hold the skin incision open, providing access and visibility to the affected area.

The diseased or damaged disc is removed to reduce pressure from the symptomatic cord or nerve root.

 

An appropriate implant, chosen by your surgeon, will be placed into the disc space to restore the proper disc height and provide mechanical support while bone grows between the vertebral bodies during the fusion (bone healing) process. That segment of your spine will eventually stabilize once fusion occurs.

Generally, some method of internal fixation will be used to act as a stabilization device (internal brace) to help hold everything in place while fusion occurs. This could be a combination of screws and plates that are affixed to the adjacent vertebrae. Your surgeon will determine what, if any, kind of fixation is necessary during the procedure.

After surgery you will wake up in the recovery room, where your vital signs will be monitored and your immediate postoperative condition will be carefully observed. Most patients stay in the recovery room between one and three hours after surgery. Once the medical staff feels that you are doing well, you will be returned to your room in the hospital. It is normal for your incision to be sore immediately after surgery.

Most XLIF patients are discharged from the hospital within 1-2 days after surgery, but your physician will determine the best postoperative course for you. The day after your surgery, your physician may instruct you to use a brace for a period of time to assist with the spinal fusion process. Supervised by trained medical professionals, your physician may ask you to carefully sit, stand, or walk within 24 hours of the surgery. Once you are discharged from the hospital it is important to limit your activities for a period of time (determined by your healthcare provider) to give your body a chance to heal. Your physician will discuss with you any pain medications to take home, as well as a prescribed program of activities. Your physician will provide instructions on wound care, exercises, and limitations to postoperative activity.

Are there risks involved?

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. Please contact your physician to discuss all potential risks.

CAN I SHOWER AFTER SURGERY?

Depending on your surgical incision, you may have showering restrictions. Ask your physician for appropriate instructions.

WILL I HAVE A SCAR?

Your physician will discuss the incisions that will be made during an XLIF surgery. Very small scars of approximately one inch are common.

WHEN CAN I DRIVE?

For a period of time after your surgery, you may be cautioned about activities such as driving. Your physician will tell you when you may drive again.

CAN I TRAVEL?

The implants used in the XLIF procedure may activate a metal detector. Because of increased airport security measures, please call your local airport authority before traveling to get information that might help you pass through security more quickly and easily. Ask your physician to provide a patient identification card.