Extreme Lateral Interbody Fusion (XLIF) Procedure | GetWellGo

XLIF Surgery

XLIF surgery refers to a surgical technique called Extreme Lateral Interbody Fusion. This technique is used to treat many different spine disorders, with a focus on those that affect the lower back area. Below is an overview:

What Is XLIF Surgery?

XLIF involves fusing the vertebrae from the side of the body, unlike traditional spinal fusion procedures which enter the spine from either the front or back. Performing the surgery on the side of the body allows the surgeon to avoid cutting through large muscles in the back and minimizes post-operative pain.

XLIF Procedure

XLIF is a minimally invasive spinal fusion surgery performed by accessing the spine from the side of the patient’s body (a lateral approach) which spares prominent back muscles and organs.

Overview of How the XLIF Procedure Is Performed

Preoperative Preparation

• The patient lies on their side (lateral position) for the whole procedure.
• General anaesthesia is administered.
• An x-ray guide is used during the operation.
• Neuromonitoring helps prevent harm to nerves, particularly the lumbar plexus.

Surgical Access

• A two- to three-centimeter incision is placed on the side of the patient’s abdomen or flank.
• Access to the damaged disc space is achieved by carefully retracting muscles to avoid cutting any of them.
• The surgeon inserts dilators and a tubular retractor to keep an access for the spine open.

Disc Removal (Discectomy)

• The surgeon locates the herniated disc that is causing the symptoms.
• The disc is carefully removed.
• Specialized instruments are used to ready the disc space for fusion.

Implant Insertion (Interbody Spacer)

• A piece of bone or processed bone is placed inside the implant.
• The spacer is used to fill the disc space and help bring the vertebrae back into proper position.
• The spacer provides support to the spine so that adjacent vertebrae can grow together.

Stabilization (if required)

• Sometimes screws, rods or lateral plates are needed to provide further support and strength to the affected spine.
• Additional posterior procedures can be performed to provide extra stability.

Closure

• With the retractor and dilators out of the way, the bones are moved apart to restore normal spacing.
• The incision is stitched together using either sutures or surgical glue.
• A bandage is applied.

Minimally Invasive Spine Surgery

MISS uses smaller incisions, preserves surrounding muscle and allows for a quicker recovery when treating spinal problems compared to open surgery.

Key Features of MISS

• Incisions made using instruments that are only 1–2 inches long.
• Doctors use small, hollow tubes to expand the tissue and replace injured discs under visual guidance from special cameras.
• Less blood loss
• Less muscle damage
• Quicker recovery and shorter hospitalization timeframes.
• Lower infection risk

Types of MISS procedures

• XLIF (eXtreme Lateral Interbody Fusion): Stop the spine from moving out of position while bones heal.
• TLIF (Transforaminal Lumbar Interbody Fusion): Takes out disc from one side of spine and places fusion device in its place.
• PLIF (Posterior Lumbar Interbody Fusion): Gently takes out the disc and places a bone graft behind the vertebrae from the back.
• ALIF (Anterior Lumbar Interbody Fusion): Gains entry through incision in person’s abdomen to reach the spine.
• Discectomy: Surgically taking out part of the disc that is putting pressure on the nerves.
• Laminectomy/Laminotomy: Removes material impinging on the spinal cord.
• Endoscopic Spine Surgery: Surgeon uses a special tube with a camera (an endoscope) to perform the procedure through a tiny cut
• Kyphoplasty/Vertebroplasty: Non-surgical treatment for broken bones in the back.

XLIF Recovery Time

Recovery from eXtreme Lateral Interbody Fusion (XLIF) is generally faster and less complicated than open back surgery because it is less invasive. Complete recovery still takes many stages, depending on overall health, surgical difficulty, and compliance with post-op care.

XLIF Recovery Timeline

Immediate Post-Op (Day 0–2)

• Hospital stay: 1–2 days
• Patients usually walk the same or following day
• Pain tends to be mild to moderate and treated with oral medication
• Start gentle movement with guidance

First 2 Weeks

• Slow return to regular daily activities (with caution)
• No twisting, bending, or heavy lifting
• Gentle walking promoted to aid circulation and healing
• Temporary numbness or tingling in the thigh may be experienced

2–6 Weeks

• Returning to a desk job or light work may be feasible
• Physical therapy usually starts (if ordered)
• Most patients can do light household work

6 Weeks–3 Months

• The bone fusion starts to harden
• More physical activity and therapy exercises
• May resume more normal activity, but not heavy lifting or contact sports

3–6 Months

• Bone fusion still ongoing; most individuals 80–90% recovered
• Return to more severe work or activity may be possible with surgeon's permission

6–12 Months

• Complete spinal fusion generally finished
• Long-term relief in pain, mobility, and function
• Last imaging (X-ray/CT) can ensure solid fusion

XLIF Complications

Although XLIF is safe in most cases and has fewer complications than open spinal surgery, as with any surgery, it does come with some risks and complications. These can be minor and temporary, or more severe and chronic.

Common Complications

• Nerve Injury (especially Lumbar Plexus)
• Psoas Muscle Irritation
• Nonunion (Pseudoarthrosis)
• Implant Complications
• Infection
• Bleeding or Vascular Injury
• Bowel or Organ Injury
• Thigh Sensory Issues
• Adjacent Segment Disease

XLIF vs TLIF

XLIF

• XLIF is done by a small incision to the side of the body, with a lateral approach passing through the psoas muscle. This permits the spine access without opening up back muscles, resulting in less postoperative pain. 
• XLIF traverses the psoas muscle; it has a greater risk of transient thigh paresthesia, groin discomfort, or weakness of hip flexors, since the lumbar plexus is housed in the psoas muscle. Surgeons employ intraoperative neuromonitoring in XLIF to prevent nerve injury. 
• XLIF employs a larger interbody cage that is capable of more effectively restoring disc height and creating a superior environment for fusion. But it usually needs posterior fixation (such as rods and screws) performed in an independent procedure or simultaneously. 
• XLIF is particularly beneficial for the treatment of adult degenerative scoliosis and spinal realignment without significant muscle damage. It is less ideal for individuals with major spinal canal stenosis since it does not permit straight decompression of the spinal cord. 
• Patients who receive XLIF generally have less postoperative pain, shorter in-patient stays (1–2 days), and quicker return to normal activity (2–6 weeks) because there is less muscle damage. 
• XLIF is more complicated and costly than TLIF because it needs specialized equipment, imaging, and neuromonitoring. It is not available in every hospital and is performed by highly skilled spine surgeons with expertise in lateral approaches.

TLIF

• TLIF (Transforaminal Lumbar Interbody Fusion) is performed from behind. The spine muscles are retracted or cut to access the disc space within the vertebrae. This approach from the back enables direct visualization of the spinal canal but results in greater muscular disturbance.
• In TLIF, nerves most at risk are the spinal nerve roots and dural sac. Although TLIF does affect nerves, the risk tends to be better appreciated and controlled, particularly because it enables direct decompression of nerves involved.
• TLIF employs a smaller cage implanted from behind, and fixation is carried out while approaching in the same manner that will possibly make the operation more efficient in some instances.
• TLIF is, however, very good for those with nerve root compression or spinal stenosis because it enables direct extraction of disc and bone material compressing nerves. TLIF is also the choice in revision operations when the patient has previously been operated on for the spine through the back.
• TLIF patients have potentially longer hospital stays (2–4 days) and recovery time (4–8 weeks) due to more tissue disruption.
• TLIF is done more frequently, utilizes routine spinal instrumentation, and is more readily available, particularly in community centers and smaller hospitals.

XLIF Spinal Fusion

XLIF spinal fusion is a minimally invasive technique to treat different spinal ailments by taking out a degenerated disc and joining two or more vertebrae together. As opposed to conventional fusion operations that are applied from the back (posterior) or front (anterior) of the body, XLIF approaches the spine via the patient's side (lateral approach) and goes through the psoas muscle.

Factors Affecting XLIF Surgery Cost

The price of XLIF spinal fusion surgery can range widely depending on a number of medical, hospitals, geographic, and patient-specific factors. Here's a detailed breakdown of what influences the overall cost:

• Hospital Type and Location
• Surgeon's Expertise
• Complexity of the Case
• Type of Implants and Materials Used
• Preoperative and Postoperative Care
• Inclusions and Package Type
• Medical Tourism Services