The most common indication for lumbar fusion is degenerative disc disease (DDD) (discogenic pain). Spinal fusion may also be indicated for conditions related to DDD, including abnormal slippage of the vertebrae (spondylolisthesis or spondylolysis), a sideways curvature of the spine (scoliosis), facet joint degeneration, infection (e.g., discitis, tuberculosis), tumors, and fractures.

Description of Technology: In the extreme lateral lumbar interbody fusion (XLIF) procedure, the disc is accessed from the side of the spine through the psoas muscle, typically with the patient under general anesthesia. The patient is positioned on the side and the surgeon makes a small incision in the flank for the probe. The peritoneum is manually removed from the abdominal wall. A probe is inserted through the large psoas muscle, which is split but not cut. Intraoperative nerve monitoring (electromyography) is used to assist in prevention of neural injury within the psoas muscle. A second small guide incision is made, and a dilator or series of dilators and a retractor are inserted to provide direct access to the spine. The discectomy is then performed with specialized tools. A spacer implant is inserted through the same incision and bone graft is inserted. Correct spacer placement is confirmed by x-ray. Depending on the patient’s diagnosis, supplemental support such as rods, plates, or screws may be added.

Patient Population: The most common indications for XLIF are DDD and related conditions of spondylolisthesis and scoliosis. The XLIF procedure is considered suitable for defects from T12-L1 to L4-L5.

Clinical Alternatives: The major surgical alternatives to XLIF for interbody fusion of the lumbar spine include: anterior lumbar interbody fusion, posterior lumbar interbody fusion, transforaminal lumbar interbody fusion (TLIF) or minimally invasive TLIF, or oblique lumbar interbody fusion/anterior to psoas.

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