**9. Patient perceptions**

While more research is needed to further quantify the advantages and disadvantages of XLIF compared to conventional approaches, patient perceptions and expectations play an important role in the utilization of this newer technique. Presently, no study has investigated the role and impact of patient requests and perceptions in the decision-making process for which specific surgical approach is ultimately performed for lumbar spine pathologies. However, a recent study conducted by Narain et al. [64] found that prospective spine surgery patients with degenerative spine disorders overwhelmingly preferred a minimally invasive approach. These patients perceived open surgery to be more painful, having a higher complication rate, having prolonged recovery time, more expensive, and requiring heavier sedation compared to MIS. While this study clearly suggests that offering minimally invasive procedures is a highly marketable skill for spine surgeons, it also highlights the importance of setting realistic patient expectations for the operative and postoperative course. Spine surgeons will need to attenuate patient perceptions in the clinic with unbiased discussions on the advantages and disadvantages of XLIF compared to alternative approaches in the joint decision-making process to ensure proper clinical management.
