XLIF - eXtreme Lateral Interbody Fusion

XLIF (eXtreme Lateral Interbody Fusion) is a gentle, less invasive spinal fusion alternative for patients whose spinal condition requires a fusion to be fixed. This minimally invasive fusion method allows the surgeon to approach the spine from the side (lateral) of the patient rather than the front (anterior) or the back (posterior).

Since it avoids traversing through the abdomen or cutting and disrupting the muscles of the back, XLIF allows for a less painful surgery with fewer traumas to the body than traditional open fusion surgery. The patient can recover in weeks instead of months required for traditional fusion techniques.

Why is the XLIF Surgery better than traditional spine fusion?


XLIF Procedure Overview

Why is the XLIF Surgery better than traditional spine fusion?


  • Hospital Stay
  • Blood Loss
  • Walking
  • Return to Normal Activity

XLIF Surgery

  • 1-2 days
  • Less than 100cc
  • Same day
  • 4-6 weeks

Traditional Spine Fusion

  • 3-5 days
  • 300-600cc
  • 2-4 days
  • 6 months or longer

Source: Wright N, XLIF - the United States experience 2003-4, International Meeting on Advanced Spine Techniques, 2005, Banff, Canada.

The XLIF procedure provides relief to patients who cannot tolerate open back surgery because of its known drawbacks. This minimally invasive fusion is made safe with the assistance of advanced nerve monitoring system that provides the surgeon with accurate, reproducible, real-time feedback about nerve health, location, and function, reducing the incidence of nerve injury during surgery.

When Is XLIF Recommended?

XLIF is recommended for thoracic lumbar spinal conditions located at above L5-S1 that requires a fusion and can be accessed from the side of the body.

What Conditions Can XLIF Surgery Treat?

XLIF Can Treat:

  • Lumbar degenerative disc diseases
  • Low-grade spondylolisthesis
  • Degenerative scoliosis
  • Spinal deformity
  • Recurrent lumbar disc herniations
  • Foraminal stenosis requiring disc height restoration
  • Thoracic disc herniation

XLIF Can Not Treat:

  • Spinal conditions located at the lowest level of the spine (below L5 level)
  • Some spinal deformities with significant rotation
  • High-grade spondylolisthesis
  • Bilateral retro-peritoneal scarring caused by prior abscess or abdominal surgery

How Is XLIF Surgery Done?

During an XLIF minimally invasive fusion procedure, the spine is approached through small incisions made on the patient’s side. Under the guidance of x-rays, a dilator is inserted between the abdomen and the spinal muscles. To make sure nerves are not harmed or irritated during the process, neuromonitoring (testing of the nerves) is conducted during the procedure to provide the surgeon with real-time information about the position of the nerves related to his instruments.

Once the dilator is precisely positioned, a retractor is put into place so that the surgeon can approach the target disc. With this direct access, the surgeon is able to remove the target disc material. And after the disc material is removed, an implant is inserted through the same lateral incision. A spacer cage is then used to help hold the vertebrae in the proper position to make sure the disc height is correct and the spine is properly aligned. This spacer together with the bone graft will allow the spine to fuse.

Sometimes, depending on the diagnosis of the condition, additional support is needed to hold the vertebrae in place during the surgery. In this case, the surgeon may also decide to put in additional implants, such as screws, plates or rods for added support.

What Will My Recovery After XLIF Surgery Be Like?

XLIF is a minimally invasive surgery from which patients generally recover easily. The length of time the patient is required to stay under physician care varies from patient to patient. Many patients are able to go home a day or two after the spinal fusion surgery.

Furthermore, many patients notice an improvement in their symptoms immediately after spinal fusion surgery. In other patients, symptoms go away gradually. Since the minimally invasive fusion surgery does not cut muscles, but rather splits them, many patients are able to get up and walk around the night after they’ve had spinal fusion surgery. Local tenderness, however, is normal and should be expected.

Overall, the total recovery time is relatively short, and most patients are able to quickly return to their normal activities.

What Are the Risks of XLIF Surgery?

The XLIF procedure, like any other surgical procedure, has certain potential risks and complications associated with it. As with any surgical procedure, we will discuss all potential risks of the XLIF procedure before a decision is made.

Some of the possible risks and complications include, but are not limited to:

  • Persistent pain after surgery
  • Failure to fuse
  • Infections
  • Muscle weakness
  • Vascular injury
  • Neurologic injury
  • Urinary tract infection
  • Stroke
  • Pneumonia
  • Deep vein thrombosis

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