The NuVasive X360 portfolio is designed to provide you with comprehensive pathology, anatomy and surgeon-driven solutions to deliver the best possible patient outcomes. Our core anterolateral procedures, Supine ALIF, XALIF, XLIF—inclusive of XFixation, and X360 SPS have all been validated by clinical data.
Supine ALIF provides unique benefits over traditional posterior surgical approaches in the lower lumbar spine. The Supine ALIF access system is designed by and for access surgeons to drive reproducibility. By combining strength, precision, fluoro visibility and a variety of instrument options, the system supports improved clinical outcomes.
XALIF utilizes a similar surgical approach to traditional supine ALIF but is performed with the patient in the lateral decubitus position. The versatile XALIF retractor system enables access to multiple lower lumbar levels and reduces the need for patient repositioning, which has demonstrated a reduction in OR times1, patient time under anesthesia,2-3Â and hospital cost savings.4-5
Partnering with the best spine clinicians from around the globe, NuVasive developed and validated rote procedural steps, introduced technologies like NVM5 to enable surgeons through intraoperative neuromonitoring, continued to innovate throughout a procedurally integrated portfolio of access, interbody, fixation, biologics and enabling technologies, and introduced world-class training and education programs to ultimately create what we believe is the best procedure in spine, XLIF.
The XLIF technique is a minimally disruptive surgical procedure performed through the side of the body. The XLIF procedure does not require an anterior or posterior exposure, and thereby does not present the same risks of vascular and/or neural injury as traditional approaches. It is designed to treat a range of spinal pathologies.
XLIF is effective and reproducible at addressing pathologies at L4–L5 and above from the lateral decubitus position. Clinically validated, with ~300,000 procedures performed and over 500 peer-reviewed articles,6 XLIF has demonstrated more predictable outcomes than traditional posterior spinal fusion procedures, with substantially fewer complications.7-11
An XLIF approach used to treat patients suffering from severe spinal conditions resulting from trauma or tumors where a large part of the vertebral body must be removed and replaced. 
Designed for patients with challenging direct lateral anatomy, transitional segments or high iliac crests, XLIF Crestline equips surgeons with another anterolateral approach for patient-specific variances. 
XLIF ACR is an alternative to conventional posterior approaches, that addresses sagittal plane imbalance from the anterior column. This approach provides enhanced lordotic correction through the release of the anterior longitudinal ligament, and anterior placement of hyper-lordotic implants.
The XLIF Thoracic procedure enables access to the thoracic spine via a direct-lateral approach. This approach is equipped with various rib dissection tools and implant sizes, XLIF Thoracic enables treating the thoracic spine via a retro pleural approach.
reduction in operative time12
reduction in infection rates15
fusion rate13
reduction in blood loss16-18
reduction in revision rates15
achievement of indirect decompression14
reduction in hospital stay15
XFixation is an adapted posterior fixation procedure with the patient kept in a lateral decubitus position. This allows single-position surgery to be achieved from the upper thoracic spine to the sacrum when combined with XLIF and/or XALIF.
X360 SPS is a comprehensive approach to lateral single-position surgery enabled by a combination of less invasive procedural solutions: XALIF, XLIF, and XFixation. The ability to bring these approaches into an efficient operative workflow while keeping the patient in a single position allows surgeons to craft treatment plans for pathologies across the thoracolumbar spine.
X360 SPS can reduce patient time under anesthesia and lower associated intraoperative risks.19,20
The efficiencies of X360 SPS can grant time back into the surgeon's schedule, increase clinical productivity and reduce radiation by 64%.23
Patients experienced a reduced length of stay in the hospital on average 1.7 less days compared to AP flip procedures.21,22
Supine ALIF provides unique benefits over traditional posterior surgical approaches in the lower lumbar spine. The Supine ALIF access system is designed by and for access surgeons to drive reproducibility. By combining strength, precision, fluoro visibility and a variety of instrument options, the system supports improved clinical outcomes.
Hear from Dr. Veeravagu as he shares his experience with the NuVasive ALIF portfolio and how the access, interbody implants and instrumentation are all designed around achieving indirect decompression and interbody fusion.
XALIF utilizes a similar surgical approach to traditional supine ALIF but is performed with the patient in the lateral decubitus position. The versatile XALIF retractor system enables access to multiple lower lumbar levels and reduces the need for patient repositioning, which has demonstrated a reduction in OR times1, patient time under anesthesia,2-3Â and hospital cost savings.4-5
Partnering with the best spine clinicians from around the globe, NuVasive developed and validated rote procedural steps, introduced technologies like NVM5 to enable surgeons through intraoperative neuromonitoring, continued to innovate throughout a procedurally integrated portfolio of access, interbody, fixation, biologics and enabling technologies, and introduced world-class training and education programs to ultimately create what we believe is the best procedure in spine, XLIF.
The XLIF technique is a minimally disruptive surgical procedure performed through the side of the body. The XLIF procedure does not require an anterior or posterior exposure, and thereby does not present the same risks of vascular and/or neural injury as traditional approaches. It is designed to treat a range of spinal pathologies.
XLIF is effective and reproducible at addressing pathologies at L4–L5 and above from the lateral decubitus position. Clinically validated, with ~300,000 procedures performed and over 500 peer-reviewed articles,6 XLIF has demonstrated more predictable outcomes than traditional posterior spinal fusion procedures, with substantially fewer complications.7-11
An XLIF approach used to treat patients suffering from severe spinal conditions resulting from trauma or tumors where a large part of the vertebral body must be removed and replaced. 
Designed for patients with challenging direct lateral anatomy, transitional segments or high iliac crests, XLIF Crestline equips surgeons with another anterolateral approach for patient-specific variances. 
XLIF ACR is an alternative to conventional posterior approaches, that addresses sagittal plane imbalance from the anterior column. This approach provides enhanced lordotic correction through the release of the anterior longitudinal ligament, and anterior placement of hyper-lordotic implants.
The XLIF Thoracic procedure enables access to the thoracic spine via a direct-lateral approach. This approach is equipped with various rib dissection tools and implant sizes, XLIF Thoracic enables treating the thoracic spine via a retro pleural approach.
reduction in operative time12
reduction in infection rates15
fusion rate13
reduction in blood loss16-18
reduction in revision rates15
achievement of indirect decompression14
reduction in hospital stay15
XFixation is an adapted posterior fixation procedure with the patient kept in a lateral decubitus position. This allows single-position surgery to be achieved from the upper thoracic spine to the sacrum when combined with XLIF and/or XALIF.
X360 SPS is a comprehensive approach to lateral single-position surgery enabled by a combination of less invasive procedural solutions: XALIF, XLIF, and XFixation. The ability to bring these approaches into an efficient operative workflow while keeping the patient in a single position allows surgeons to craft treatment plans for pathologies across the thoracolumbar spine.
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1. Drazin D, Kim TT, Johnson JP. Simultaneous lateral interbody fusion and posterior percutaneous instrumentation: early experience and technical considerations. Biomed Res Int 2015:Article ID 458284.
2. Olsen MA, Mayfield J, Lauryssen C, et al. Risk factors for surgical site infection in spinal surgery. J Neurosurg 2003;98(2):149-55.
3. Olsen MA, Nepple JJ, Riew KD, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 2008;90(1):62-9.
4. Macario A. What does one minute of operating room time cost? J Clin Anesth 2010;22(4):233-6.
5. Shippert RD. A study of time-dependent operating room fees and how to save $100,000 by using time-saving products. Am J Cosmet Surg 2005;22(1):25-34.
6. Data on file
7. Lehmen JA, Gerber EJ. MIS lateral spine surgery: A systematic literature review of complications, outcomes, and economics. Eur Spine J 2015;24(Suppl 3):287-313.
8. Cheng I, Briseno MR, Arrigo RT, et al. Outcomes of two different techniques using the lateral approach for lumbar interbody arthrodesis. Global Spine J 2015;5(4):308-14.
9. Khajavi K, Shen A, Lagina M, et al. Comparison of clinical outcomes following minimally invasive lateral interbody fusion stratified by preoperative diagnosis. Eur Spine J 2015;24(Suppl 3):322-30.
10. Okuda S, Miyauchi A, Oda T, et al. Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients. J Neurosurg Spine 2006;4(4):304-9.
11. Scaduto AA, Gamradt SC, Yu WD, et al. Perioperative complications of threaded cylindrical lumbar interbody fusion devices: anterior versus posterior approach. J Spinal Disord Tech 2003;16(6):502-7.
12. Sembrano JN, Tohmeh A, Isaacs R, et al. Two-year comparative outcomes of MIS lateral and MIS transforaminal interbody fusion in the treatment of degenerative spondylolisthesis: part I: clinical findings. Spine 2016;41(Suppl 8):S123-32.
13. Rodgers WB, Gerber EJ, Patterson JR. Fusion after minimally disruptive anterior lumbar interbody fusion: analysis of extreme lateral interbody fusion by computed tomography. SAS Journal 2010;4:63-6.
14. Gabel BC, Hoshide R, Taylor W. An algorithm to predict success of indirect decompression using the extreme lateral lumbar interbody fusion procedure. Cureus 2015;7(9):e317.
15. 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 Manag Healthc Policy 2012;5:65-74.
16. Dakwar E, Cardona RF, Smith DA, et al. Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurg Focus 2010;28(3):E8.
17. Dhall SS, Wang MY, Mummaneni PV. Clinical and radiographic comparison of mini-open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up. J Neurosurg Spine 2008;9(6):560-5.
18. Whitecloud TS, Roesch WW, Ricciardi JE. Transforaminal interbody fusion versus anterior-posterior interbody fusion of the lumbar spine: a financial analysis. J Spinal Disord 2001;14(2):100-3.
19. Nelson et al. Fundamental concepts of lumbar fusion and single-position circumferential lumbar interbody fusion. Science Direct 2022.
20. Olsen et al. Risk factors for surgical site infection following orthopaedic spinal operations. The Journal of Bone and Joint Surgery 2008;62-69.
21. Buckland et al. Lateral decubitus single position anterior posterior surgery improves operative efficiency, improves perioperative outcomes, and maintains radiological outcomes comparable with traditional anterior posterior fusion at minimum 2-year follow-up. The Spine Journal 2023;685-694.
22. Dietz et al. Enhanced Recovery After Surgery (ERAS) for Spine Surgery: A Systematic Review. World Neurosurgery 2019; 415-426.
23.Buckland AJ et al. Single position circumferential fusion improves operative efficiency, reduces complications and length of stay compared with traditional circumferential fusion. Spine J. 2021 May; 21(5):810-820.