Lateral Lumbar Interbody Fusion (XLIF) is a minimally invasive procedure in which the surgeon approaches the disc space in the lower back (lumbar spine) from the patient’s side.

The surgeon can use XLIF to treat the region above L5-S1 in patients suffering from degenerative disc disease, spinal stenosis, recurrent disc herniation, and spinal instability in the lower back. The surgeon makes a small incision directly over the side of the waist. This procedure is less invasive than the typical lumbar fusion from either the front or the back. The spinal muscles are spared during this approach, leading to a faster recovery and typically less post-operative pain. The disc is removed, and a cage packed with porous bone graft is inserted in the empty disc space and secured with pedicle screws and rods. The bone grows through the holes in the cages, fusing the two vertebrae together.

You will need a complete physical exam to be sure you are in good health. A blood test, electrocardiogram (EKG), and chest X-ray need to be performed. Discuss all medications (prescription, over-the-counter, and herbal supplements) you are taking with your health care provider. Some medications need to be continued or stopped the day of surgery.

Medications that thin the blood should be stopped prior to surgery. Your Internist or primary doctor should be consulted prior to changing or discontinuing any medications. Also, stop drinking alcohol 1 week before and 2 weeks after surgery because these activities can cause bleeding problems. An important thing you can do to ensure the success of your spinal surgery is to quit smoking. This includes cigarettes, cigars, pipes, chewing tobacco, and smokeless tobacco. Nicotine prevents bone growth and puts you at higher risk for a failed fusion.

Morning of surgery

  • Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.
  • Wear flat-heeled shoes with closed backs.
  • If you have instructions to take regular medication the morning of surgery, do so with small sips of water.
  • Remove make-up, hairpins, contacts, body piercings, nail polish, etc.
  • Leave all valuables and jewelry at home (including wedding bands).
  • Bring a list of medications (prescriptions, over-the-counter, and herbal supplements) with dosages and the times of day usually taken.
  • If you have a cold, fever or some other illness the day before surgery, please call your surgeons office.
  • Bring a list of allergies to medication or foods.

Under general anesthesia, the surgeon makes an incision several inches long to allow access to the spine. Xray guidance is used to approach the appropriate disc. The surgeon removes most of the painful disc, taking care not to go too deep. Next, the fusion part of the surgery takes place. A cage device containing bone graft material will be inserted into the disc space. Xray guidance is again used significantly to direct the placement of the implants.

Lastly, the bone graft and vertebrae must be immobilized while the bone graft and bed heals and fuses. The fusion area is often immobilized and held together with metal plates, rods, screws, or cages. The surgeon closes the incision with dissolvable sutures and you are taken to recovery. The advantage of this method is that it provides instant stability and will not slip.

After XLIF spinal fusion surgery, patients with 1-2 operated levels are typically allowed to go home the day of surgery. For patients with larger numbers of levels, they are typically admitted to the hospital for an average of 1-2 days. Blood transfusion is rarely required. Patients are gradually mobilized. A spinal brace may be used. Physical therapy is begun about 2 weeks after surgery. Patients are discharged on limited activity with oral pain medicine and will follow up with the surgeon in a few weeks. Patients can generally return to office work in four to six weeks, or longer if the patient’s occupation is heavier. Bone fusion can take a year or more to become solid. Most patients will have activity restrictions for 6-7 months to allow for the fusion to be well into the healing process.

For patients with disabling back pain and leg pain and appropriate indications, significant benefits can be obtained with a successful spinal fusion. Physical therapy is generally encouraged for a few months following surgery. A reasonable expectation is for pain to be relatively well controlled with occasional over the counter pain medication when performing basic daily activities. Patients will on average attain a 50 pound weight restriction by around 6 months after surgery. It is important to remember these are general averages and that some patients do better and some do worse.