Fall 2010 Issue

Direct Lateral Spinal Fusions:
A New Minimally Invasive Approach


The XLIF® procedure uses a lateral approach to
pass through the psoas muscle to the disc space.
Click here to view an animation of the procedure.
As Terri disembarked from a recent cruise, you would never know that the 53-year-old female was recovering from spine surgery. Just a few weeks prior, she had an XLIF® procedure, also known as a direct lateral fusion. This minimally invasive spine surgery results in reduced surgical times, less tissue damage, shorter hospital stays, minimal scarring, and a faster return to normal activities.

"I was very surprised when she told me about the cruise at a recent post-op appointment," said her spine surgeon Paul Kim, MD, of Carolina Neurosurgery & Spine Associates. "It really speaks to the dramatic improvement the surgery made for her and how quickly she recovered."

Prior to the procedure, Terri was suffering from spinal degeneration and stenosis at L1-2 and experiencing intense pain that radiated down her hamstring to her knee. Based on her condition and history of four previous spine surgeries above L2-S1, Dr. Kim suggested XLIF surgery.

The Procedure
In an XLIF procedure, the spine is approached from the side of the body to repair discs above L5-S1. The patient is positioned on the surgical table on his or her side. Two small incisions are made: one directly over the side of the waist (through which most of the procedure is performed),
and the other slightly behind the first, toward the back muscles (through which the surgeon’s finger safely guides the approach). Nerve monitoring technology adds another level of safety to the lateral approach.

The purpose of the fusion is to eliminate instability to the back caused by degenerated discs and/or facet joints. Unnatural motion and pain, pinched spinal nerves, slippage of one vertebra over another, or change in the normal curvature of the spine can result from this instability. Related symptoms include back pain, leg pain, or muscle weakness that extends into the hips, buttocks and legs.

During fusion procedures, disc material is removed from in between two adjacent vertebrae. An implant and bone graft material are then placed into the disc space to promote bone growth that permanently fuses together the two vertebrae. Rods and screws are then placed posteriorly to support the area during the healing process.

Advantages of XLIF
Traditional fusion surgery options include anterior lumbar interbody fusion [ALIF], that involves an incision in the patient's abdomen. Posterior lumbar interbody fusion [PLIF] and transforaminal lumbar interbody fusion [TLIF] both use an incision in the patient's back. The lateral approach of XLIF appears to have several distinct advantages over these procedures.


"In general, it is less painful, and patients usually go home on post-op day 1 or 2. Success rates continue to be very good," said spine surgeon Daniel Oberer, MD, of Carolina Neurosurgery & Spine Associates.

COMPARING PLIF AND XLIF
Traditional Posterior Lumbar Interbody Fusion
(PLIF) exposure involves bilateral resection of
back muscles, bone, and posterior ligaments.
The XLIF procedure avoids cutting of muscle or bone, resulting in shorter hospital stays and faster recovery.

Compared to anterior approaches, lateral access does not require abdominal exposure or present the same risk of vascular injury. Unlike traditional posterior procedures, the lateral fusion procedure does not require the cutting or retraction of back muscles, bones, ligaments, or nerves. As a result, operating time is often reduced, patient blood loss is minimized, and recovery time is significantly shorter.

To learn more about XLIF surgery, contact Carolina Neurosurgery & Spine Associates at 1-800-344-6716.

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