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What is Lateral Lumbar Interbody Fusion?

The back is made up of a number of small bones called vertebrae. Cushioning discs present between the vertebrae act as shock absorbers. The vertebral column allows the cylindrical bundle of nerve fibers called the spinal cord to pass through the entire column length and branch out to the various parts of the body. Any damage or deformity to the bones of the vertebral column or to the intervertebral discs can damage these nerves, leading to pain in the body part that the nerve supplies.

Lateral lumbar interbody fusion also known as extreme lateral (XLIF) or direct lateral interbody fusion (DLIF) is a minimally invasive spinal procedure performed to treat back and leg pain caused by degenerative discs and other problems within the vertebral column. Interbody fusion involves the fusing of the affected vertebrae found in the lumbar region (lower back). In lateral lumbar interbody fusion, your doctor will access the spine from incisions made in your side.

Indications of Lateral Lumbar Interbody Fusion

Lateral lumbar interbody fusion is indicated for:

  • Degenerative disc disease: wearing out of intervertebral discs with age
  • Scoliosis: abnormally curved spine
  • Spinal stenosis: narrowing of the spinal canal
  • Spondylolisthesis: slipping of the vertebra from their normal position
  • Fractures
  • Infections and
  • Tumor

XLIF is not recommended in the following situations:

  • When the displacement of the vertebrae in degenerative spondylolisthesis is greater than 50%
  • Severe compression of a spinal nerve
  • Presence of scarring from prior surgery or abscess

Surgical Procedure of Lateral Lumbar Interbody Fusion

When medication and conservative treatments fail to improve your back pain, your doctor may recommend a lateral lumbar interbody fusion procedure (XLIF).

XLIF usually takes about one hour and is performed under general anesthesia. You will be placed on the operating table, positioned on your side. Your surgeon will use X-rays to identify the location of the degenerated disc and will mark your skin over this area of your spine. A small incision is made in your lower back region through which your surgeon inserts a finger to protect the abdominal lining from the instruments to be inserted laterally. Your surgeon will then make a second incision on your side in order to introduce the operating instruments. X-rays and nerve monitoring devices are used during the procedure to prevent damage to the adjacent tissues and nerves.

Your surgeon removes the degenerated intervertebral disc and prepares the disc space for fusion. A stabilizing disc implant is inserted into the empty disc space. The implant may be filled with bone graft, which will help in the fusion of the two vertebrae. The implant helps maintain proper disc height and provides good support to the operated spinal segment. In some cases, your surgeon may secure the implant with plates or screws for additional support. Once the implant is in position, final X-rays are taken to confirm proper placement of the implant. At the end of the procedure, the small skin incisions are closed with stitches and bandaged.