eXtreme Lateral Interbody Fusion

eXtreme lateral interbody fusion (XLIF) is a less invasive alternative for the treatment of different pathologies of the spine above L5. Minimally invasive surgery provides the opportunity to reduce surgical duration and patient length of stay, minimize damage to adjacent tissue, and improve patient satisfaction and quality of life. This is particularly relevant to spinal conditions like low back pain, sciatica, and other intervertebral disc degenerations, as they are currently associated with severe morbidity and elevated costs to the society. The lateral approach allows the access of the intervertebral disc laterally through the psoas muscle. Proper patient positioning and concomitant lumbar plexus monitoring are mandatory for the success of the procedure. The technique preserves primary segmental stabilizing structures of the spine while also permitting a wide discectomy with bilateral annular release. Thus, the approach allows the placement of a large implant that reaches the ring apophysis bilaterally, promoting a more rigid construction without the need of posterior supplementation in some cases. Disc height restoration and ligamentotaxis also generate an indirect decompression of the neural elements, which help recover coronal and sagittal balance. Spinal fusion and improvement in self-assessment questionnaires have been described in the literature. Intraoperative bleeding and damage of adjacent structures are minimal and patients are encouraged to walk on the same day, being discharged after an overnight hospital stay, on average. Transient plexopathies and hip flexor weakness are the most commonly reported complication associated with lateral access surgery, but the majority are resolved within 6 months. Lateral transpsoas approach has been shown to be a safe and effective surgical option in the treatment of spinal pathologies.