Advancements in Minimally Invasive Lateral Interbody Fusion

*Ronald Sahyouni, Luis D. Diaz-Aguilar and Donald Blaskiewicz*

## **Abstract**

Extreme lateral interbody fusion (XLIF) is a popular surgical technique to address a wide variety of spinal pathologies. The purpose of this chapter is to explore the XLIF procedure, including indications for its use, post-fusion operative outcomes, intraoperative considerations, and advantages and disadvantages over similar fusion techniques.

**Keywords:** spinal fusion, extreme lateral interbody fusion, lateral lumbar interbody fusion, minimally invasive spine surgery, lumbar spine surgery

### **1. Introduction**

Instrumented fusion of the spine is a proven method for treating a variety of spinal pathologies, such as deformity, instability and iatrogenic instability. Historically, instrumented fusion has been an open procedure, with various approaches to the spinal column including anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transformainal lumbar interbody fusion (TLIF), and posterior intertransverse fusion (PLF) [1–8]. However, advancements in minimally invasive surgery (MIS) have changed the landscape of instrumented spinal fusion procedures, and the focus of contemporary clinical practice emphasizes MIS fusion techniques because of their lower rate of complications, shorter recovery time, smaller incisions, and reduced intraoperative blood loss [9].

Extreme lateral interbody fusion (XLIF [NuVasive, San Diego, CA, USA]) is a novel minimally invasive technique in which the disc space is accessed laterally using a lateral transpsoatic approach [10]. The XLIF approach, which was introduced by Pimenta in 2001 and further developed in the same decade [11, 12], has been successfully shown to treat degenerative disc disease (DDD), deformity, trauma, tumor, and infection [13]. The purpose of this chapter is to explore the XLIF procedure, including indications for its use, post-fusion operative outcomes, intraoperative considerations, and advantages and disadvantages over similar fusion techniques.
