What Is eXtreme Lateral Interbody Fusion (XLIF)?
XLIF, or eXtreme Lateral Interbody Fusion, is a minimally invasive spinal fusion surgery. UPMC neurosurgeons offer this state-of-the-art surgery to treat many common spine problems.
In traditional spine surgery, the neurosurgeon makes an incision on the front or back of the body to reach the patient's spine. The neurosurgeon may need to cut or move delicate muscles, bones, ligaments, or nerves to reach the spine. This makes for a longer, more challenging recovery.
With XLIF, UPMC neurosurgeons reach the spine by making small incisions in the patient's side. There are no incisions in the chest or back. This means the neurosurgeon can avoid the sensitive structures of the chest and back.
Who Is a Candidate for XLIF?
Many patients are eligible for this innovative minimally invasive surgery. Your neurosurgeon may suggest XLIF if you have a variety of spinal and back conditions including:
What You Should Know About the XLIF Procedure
In spinal fusion, neurosurgeons fuse together 2 or more vertebrae. The goal of spinal fusion is to relieve pain and restore spinal stability. That goal remains the same whether the surgeon uses XLIF or a traditional open incision.
The spinal fusion surgery accomplishes this by:
- Eliminating movement between the two vertebrae.
- Restoring the spacing between vertebrae that may have become too close together will reduce the risk of nerve compression.
In XLIF, the neurosurgeon places a specialized metal “cage" between the spinal bones. The cage provides a framework to keep damaged vertebrae spaced consistently. The cage contains bone graft material.
Over time, the bone graft will cause the 2 vertebrae to fuse together. This maintains the original spacing between the vertebra while also helping to ensure that they don't compress any nerves.
Is an XLIF procedure right for me?
Choosing any kind of spinal fusion is a big decision. Expect your medical team to try conservative therapy first. This includes:
- Physical therapy.
- Lifestyle modifications.
- Optimization of overall health.
If nonsurgical treatments don't give you enough relief, it may be time to consider surgery. Your surgeon will let you know if you are a good candidate for XLIF.
Your UPMC neurosurgeon will set aside time during your initial consultation to answer your questions. Plan on bringing a list of questions with you to your appointment. Write down the answers so you don't forget.
You may want to ask:
- Why might I benefit from back surgery?
- Are there any other nonsurgical treatments I haven't tried yet?
- What are the risks of this spine surgery?
- Am I likely to need additional spine surgeries in the future?
- What might happen if I don't have back surgery now?
- What is your experience with this type of spine surgery?
- Which do you recommend for me: traditional spinal fusion or XLIF surgery?
Before the Procedure
Your neurosurgeon will give you specific guidance on how to prepare for your XLIF surgery. Expect to need some preoperative testing. Plan on completing the preoperative testing at least a week before you have surgery.
Common preoperative tests include:
- Blood test
- Chest X-ray
Stop taking aspirin, blood thinners, and anti-inflammatory medicines at least a week before surgery. Your surgeon will give you specific guidance about when to stop. You may also need to discontinue taking vitamins or other supplements.
Stop eating and drinking at least 8 hours before surgery. Your doctor may want you to take your medications that morning with a sip of water (no coffee, tea, or juice).
Your surgeon's office will give you day-of-surgery information at your preoperative visit. This includes:
- Where to park.
- When to arrive.
- Where to go for check-in.
You'll want to leave all valuables at home, and wear loose, comfortable clothing.
What to Expect During XLIF Surgery
During XLIF surgery, the surgical team will position you on your side on the operating table. The neurosurgeon will make a small incision in your side near your waistline. This is how the neurosurgeon will access your vertebrae.
Many minimally invasive surgeries require the surgeon to rely on a camera to see the surgical site. With XLIF, the surgeon uses a special tool to pull back tissue and see the surgical site directly. This improves efficiency.
The surgeon will remove the damaged disc between the affected vertebrae. Once that space is clear, the surgeon will place an implant into the disc space.
The implant will stabilize the bones of the spine. The implant will also remove pressure on the spinal nerves by restoring the disc to its full height.
UPMC neurosurgeons can complete XLIF surgery in as little as an hour. In contrast, many traditional spinal fusion surgeries take several hours to complete.
Where do UPMC neurosurgeons perform XLIF?
UPMC neurosurgeons perform XLIF at a variety of locations.
Recovery after XLIF
One of the major advantages of XLIF surgery is that the smaller incisions mean the back muscles, bones, and ligaments stay intact. With less trauma to delicate tissues, it's reasonable to expect shorter recovery times.
For example, you will probably begin walking the day of surgery. And you may need only an overnight stay in the hospital. If you have your surgery at a UPMC Outpatient Center, plan on going home the same day.
Some patients get immediate symptom relief following XLIF surgery.
You will probably be able to return to normal activity in just 3 to 6 weeks. This is faster that with traditional spinal fusion surgery, where recovery takes several months.
Risks and safety
Although relatively safe in the hands of a skilled neurosurgeon, XLIF surgery does involve some risks. Possible side effects include:
- Kidney injury.
- Damage to muscles, nerves, or blood vessels.
- Perforation of the bowel.
Other risks are common to all surgeries. These include:
- Reactions to anesthesia.
- Blood clots.
It's also possible that XLIF surgery won't ease your symptoms or may need to be redone later.
Since XLIF is not a cosmetic surgery, your health insurance should cover it as long as your neurosurgeon indicates that it's medically necessary.
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