Spinal fusion surgery connects two or more bones in the spine, known as vertebrae, to stabilize them and prevent movement. This stabilization helps reduce pain and address issues like spinal instability or nerve compression. Traditionally, surgeons accessed the spine through the front or back, often involving more extensive tissue disruption. Extreme Lateral Interbody Fusion, or XLIF, represents a modern, minimally invasive approach to spinal fusion. It offers an alternative method for addressing certain spinal conditions, aiming for stability with a different surgical entry point.
Understanding XLIF Surgery
XLIF (eXtreme Lateral Interbody Fusion) is a spinal fusion surgery that accesses the spine from the side. The procedure permanently joins two or more vertebrae, stabilizing the spinal segment, restoring disc height, and alleviating nerve pressure.
XLIF addresses conditions affecting the lumbar spine, the five vertebrae in the lower back, that cause chronic back or leg pain unresponsive to non-surgical treatments. It treats degenerative disc disease, where intervertebral discs lose elasticity and height. It also addresses low-grade spondylolisthesis, a condition where one vertebra slips forward over another. Spinal stenosis, involving narrowing of the spinal canal and subsequent nerve compression, and mild scoliosis are also treated.
The XLIF Surgical Process
The XLIF procedure is performed under general anesthesia. The patient is positioned on their side, and X-ray imaging (fluoroscopy) precisely locates the specific disc space. A small incision, usually around 1.5 inches, is then made on the patient’s side, between the ribs and hip bone.
Specialized instruments (dilators) are inserted through the incision to create a pathway to the spine. Neuromonitoring technology, such as electromyography (EMG), is continuously used to provide real-time feedback on nerve location and function, helping the surgeon navigate safely and minimize injury risk. Once the pathway is established, a retractor holds tissues open, providing clear access to the damaged disc.
The surgeon removes the damaged disc material, creating an empty space between the vertebrae. A bone graft material or an interbody cage filled with bone graft is inserted into this space. This implant restores disc height and supports the spinal segment. Over several months, new bone grows through and around the graft, fusing the adjacent vertebrae into a single, stable bone. Additional fixation, such as screws, rods, or plates, may be used for immediate stability during the fusion process.
Recovering from XLIF Surgery
Recovery from XLIF surgery involves a short hospital stay, typically one to two days. Many patients are encouraged to begin walking on the same day of surgery or the day after, promoting early mobilization. Initial pain management involves prescribed medications, with acute post-operative discomfort typically decreasing within a few weeks. Patients balance movement with rest.
During the first few weeks, activities involving bending, lifting, or twisting should be limited to protect the surgical site. Physical therapy begins shortly after surgery, focusing on gentle movements, strengthening back and core muscles, and improving overall function. This structured rehabilitation helps patients “relearn” proper body mechanics.
A gradual return to daily activities is common, with light activities possible within one to two weeks. Desk-based work resumes in four to six weeks, while more physically demanding jobs require three to six months for a full return. Complete bone healing, where vertebrae fully fuse, takes six months to over a year. Adhering to post-operative instructions from the surgeon and physical therapist supports optimal healing and long-term success.
Why XLIF is Chosen and Who Benefits
XLIF is chosen for its less invasive nature compared to traditional open spinal fusion procedures. This approach results in advantages including less blood loss and smaller external scars. Patients experience less postoperative pain and a shorter hospital stay, often requiring only an overnight stay. Minimized disruption to muscles and tissues contributes to a faster overall recovery.
This procedure is considered for conditions affecting the lumbar spine, particularly where the lateral approach is most effective. Patients with degenerative disc disease, low-grade spondylolisthesis, spinal stenosis, or mild scoliosis are suitable candidates. The lateral access allows surgeons to directly address the disc space without navigating through major back muscles or abdominal organs. Advanced nerve monitoring during XLIF contributes to its safety profile, offering effective spinal stabilization with a less disruptive surgical technique.