The lumbar spine is commonly approached posteriorly but can also be approached from anterior and laterally. The trans-psoas approach is designed to approach the lumbar disc space and allow good removal of disc material whilst avoiding the posterior neural structures. The anterior and posterior longitudinal ligaments are left intact to provide stability to the disc space but good disc clearance is achievable. In Ozgur et al. LLIF aims to address the challenges and morbidity of anterior or posterior inter body fusion techniques but has its own risks and complications as a result. The main problems the lateral approach are iatrogenic injury to structures during the approach kidney and bowel injuries are described , injury to the psoas muscle itself leading to hip flexor weakness , and injury to the lumbar plexus which is contained within the psoas injury risk increases with prolonged retractor use.
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By accessing the spine from the side of the body, XLIF Lateral Lumbar Interbody Fusion eliminates the debilitating effects of cutting back muscles, removing bone, and retracting the neural elements that are typically experienced after a conventional posterior surgical approach PLIF.
Additionally, XLIF avoids retraction of internal organs and major blood vessels as is necessary in the conventional anterior surgical approach ALIF to reach the spine. XLIF is a safe and reproducible approach with minimal disruption, making post-op recovery easier for the patient. The XLIF procedure for lumbar fusion was developed to overcome the obstacles of both anterior front and posterior back approaches to access the spine.
XLIF avoids significant musculature disruption by utilizing a natural path from the side of the body to the spine. The XLIF approach does not require back muscle and bone dissection or nerve retraction; it also allows for a more complete disc removal and predictable implant insertion, compared with traditional posterior procedures. XLIF also does not require the delicate abdominal exposure or present the same risk of vascular injury as traditional anterior procedures.
Because the procedure is less disruptive than conventional posterior or anterior surgery, most patients are able to get up and walk around within a day of the surgery. In general, XLIF surgery results in faster recovery and return to normal activities.
The less-disruptive lateral approach by NuVasive is a breakthrough for spine patients, but it is of particular benefit for active patients who want to return to their active lifestyles more quickly and easily, or those who cannot tolerate a larger, open procedure because of the increased risks of longer anesthesia time, greater blood loss, longer hospitalization, and longer recovery.
Only your doctor can determine whether you are a suitable candidate for this treatment. XLIF Surgery.
Xlif Surgical Technique Guide