Extreme lateral interbody fusion (XLIF®): how I do it

Area of Science:

• Spine surgery
• Minimally invasive techniques
• Orthopedic surgery

Background:

• The extreme lateral interbody fusion (XLIF®) approach, introduced in 2001, provides a safe alternative to traditional anterior or posterior lumbar fusion methods.
• It effectively avoids major anterior blood vessels and posterior spinal structures, including paraspinous muscles and facet joints.

Purpose of the Study:

• To detail the surgically relevant anatomy for the XLIF® approach.
• To provide a step-by-step surgical technique guide, emphasizing complication avoidance.
• To outline critical perioperative considerations for XLIF® procedures.

Main Methods:

• Detailed anatomical description focusing on the lumbar plexus, psoas muscle, and lateral spinal column.
• Step-by-step surgical technique with emphasis on complication avoidance.
• Inclusion of a video demonstration and comprehensive perioperative guidelines.

Main Results:

• The XLIF® approach allows safe access to the lateral lumbar spine.
• Key procedural elements include correct lateral positioning, orthogonal orientation, and table repositioning for multilevel cases.
• Advantages include indirect neurological decompression, minimal blood loss, shorter operative times, reduced infection rates, and increased fusion surface area.

Conclusions:

• The XLIF® approach is a safe and effective method for lumbar fusion.
• Surgeon's anatomical knowledge, intraoperative decision-making, and adherence to meticulous planning are paramount for success.
• Potential disadvantages, such as transient psoas weakness and pain, must be managed alongside the procedure's significant benefits.