What is an XLIF or Direct Lateral Fusion?

A Direct Lateral Fusion, also known as eXtreme Lateral Interbody Fusion (XLIF) is a type of spine surgery that approaches from the side, rather than the back.  XLIF is a type of Minimally Invasive Surgery. This means that endoscopic tools and procedures are used. This type of surgery holds many benefits as it requires a small incision size and results in greatly reduced trauma during the surgery.

What happens in an XLIF?

An XLIF is performed under general anesthetic and typically takes around an hour.

During an XLIF procedure, the surgeon will first make a small incision near your spine. This incision is used for the surgeon to be able to protect sensitive structures during the procedure. Another small incision is then made on your side. The surgical instruments are guided through this incision to access your intervertebral disc. The damaged disc is then removed and an implant inserted in its’ place. The implant is filled with bone graft material to allow the area to fuse. Sometimes additional support is also inserted (rods, screws or plates). The whole operation is guided by the use of endoscopic cameras, allowing highly detailed and precise surgery to occur.

Which conditions are appropriate for this type of surgery?

The type of surgery recommended for a specific condition depends on a number of factors, but if an XLIF has been recommended for you, it is likely that you have been experiencing one or more of the following conditions:

XLIF is not appropriate for everyone and your surgeon will advise whether this type of surgery is appropriate for you. For example, it cannot be used on the lowest areas of your lumbar spine.

What are the benefits of an XLIF?

XLIF is a type of minimally invasive surgery, and carries the following benefits of this approach to spine surgery:

  • Greatly decreased recovery time compared to conventional surgery
  • Much less trauma to spinal musculature and other soft tissue
  • Greatly reduced blood loss
  • Less post-operative pain
  • Less risk of post-operative infection or other complications
  • Improved mobility after surgery
  • Can often be performed as an outpatient (day surgery)

Could an XLIF benefit me?

Like all surgery, an XLIF carries some risk and is not right for everyone. Spinal surgery will usually only be considered when all other non-surgical treatment options have been trialed. For example, your doctor may first prescribe medication or send you for Physical Therapy.

The rate of relief of leg pain is high after this procedure, but some people will not experience a full resolution of their symptoms. Although each person and spine condition is different, most people who receive a XLIF will enjoy a rapid recovery and return to their previous activities.

Article Written by
Dr. Kaushik Das is a spinal surgeon in New York.