**8.1 Advantages**

One of the primary advantages to MIS surgery is the usage of smaller incisions compared to the large posterior or anterior approaches, resulting in reduced soft tissue damage, faster recovery times, and less postoperative pain. Multiple studies have described average hospital stays of just over 1 day and relatively few complications with XLIF [47, 49, 54, 55]. Additionally, unlike the ALIF, the XLIF is associated with less intraoperative blood loss [48] and lower risk of vascular injury, as major vessels such as the aorta are altogether avoided. For this reason, the XLIF conveniently eliminates the need for a vascular surgeon to either perform the ALIF approach or be on standby, which may translate to significant cost-savings. Furthermore, while there is increased risk of vascular damage in obese patient undergoing ALIF, this complication can be largely avoided by using the XLIF [56]. The XLIF also theoretically places the superior hypogastric plexus at risk, but there have been no cases of retrograde ejaculation compared to ALIF [57, 58]. Finally, the XLIF has been radiographically shown to have high rates of fusion, patient satisfaction, and patient-reported outcomes in several large studies [49, 54].
