Extreme Lateral Interbody Fusion (MIS XLIF) Information

Extreme Lateral Interbody Fusion (XLIF®) is a procedure used fuse the lumbar spine via an approach from the side of the spine. XLIF stands for:

EXtreme - minimally invasive approach to the spine and intervertebral disc, from one side, through a small flank incision usually 4-5 centremetres in length.
Lateral - approach to the spine is from the side through a small flank incision
Interbody - fusion occurs between the two vertebral bodies following removal of the intervertebral disc.  The fusion occurs accross the disc space.
Fusion - formation of  bony bridge between segments of the spine in order to stablise the spine

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Video - XLIF Spinal Fusion Explainer Video

Video Courtesy of Nebula Health

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​Unlike traditional back surgery, XLIF® is performed with the patient positioned on their side.  A small incision is made on one side in the flank region below the rib cage.   By approaching the spine in this way, major muscles at the back of the spine are avoided and not damaged. This reduces post-operative back pain.

​This common minimally-invasive procedure is generally used to treat back pain and leg pain (sciatica), caused by degenerative disc disease or disc herniation. It can also be used to treat lumbar stenosis, spondylolisthesis and some types of adult degenerative scoliosis. 

XLIF - Minimally Invasive Extreme Lateral Interbody Fusion: Image showing the large interbody fusion cage. 

​XLIF is performed under general anaesthesia.  Patients are typically in hospital for between 2 - 5 days.  The surgery takes approximately 1 hour to perform. 

​​During XLIF surgery, Dr Oehme will stabilise the spine by fusing two or more vertebrae together with bone graft material.  Following a small incision in your side, a special retractor is placed.  This retractor passes through a large muscle at the side of the spine, called the psoas muscle.   The retractor is carefully placed using sophisticated neuromonitoring techniques, thereby avoiding delicate nerves within the muscle.  Because of stretch on the nerves, called the lumbar plexus, in the psoas muscle, it is common for patients to have numbness or tingling in the thigh on the side that the retractor is positioned.  These symptoms typically improve over several weeks.  

Once the retractor is correctly placed, the damaged disc between the vertebral bodies is almost totally removed.   An interbody spacer called a cage, designed to promote fusion and restore spinal alignment, is implanted into the interbertebral space.   Performing an XLIF approach allows for a large cage (spacer) to be inserted into the disc space.  This increases fusion rates and also is more effective at restoring spinal alignment.  

The spinal segment to be fused is generally further immobilised by the insertion of a rigid metal construct, such as pedicle screws connected to rods, inserted through small incisions in the lower part of your back.  

The XLIF procedure allows for lumbar nerve decompression curing symptoms related to disc herniation and lumbar stenosis. The pressure on the nerves is relieved eliminating symptoms of leg pain and sciatica, neurogenic claudication and radiculopathy. Walking and exercise tolerance is improved.  Fusing the spine aims to improve symptoms of back pain related to degenerative disc disease and instability. 

Dr Oehme performs XLIF surgery using minimally invasive and keyhole techniques.  Patients typically several small incisions in their lumbar spine and flank, that are 3-4cm in length and have absorbable sutures, which don't need to be removed.  Patients are typically in hospital for between two and five days.  Post opreative pain is generally easily managed with oral medications.  
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​For more information about XLIF® watch the video below.

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Video - XLIF MIS Spine Fusion 

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Performing XLIF surgery using minimally invasive and keyhole techniques benefits patients by

• minimising muscle injury
• reducing blood loss
• reducing infection risk
• reducing postoperative pain
• shortening the time spent in hospital  
• utilising smaller more cosmetically favourable incisions
• reducing damage to adjacent levels

Dr Oehme routinely uses advanced spinal neuronavigation equipment for accurate pedicle screw and instrumentation placement during fusion surgery. He has access to O-arm neuronavigation and other sophisticated neuronavigation technology which minimises the chance of a complication occurring.  Dr Oehme also routinely uses intra-operative neural monitoring to minimise the possibility of nerve damage occurring.  

It is against Dr Oehme's priniciple of harm minimisation to unneccessarily take iliac crest bone graft from your hip in order to promote fusion. Where possible, Dr Oehme uses synthetic bone substitutes and local bone so that complications of chronic hip pain do not occur.  

​Dr Oehme will advise if a MIS XLIF procedure is appropriate for your spinal condition.  For more information or to arrange a time to discuss surgery with Dr Oehme contact Keyhole Neurosurgery on 1800 DO SPINE (1800 367 746).​

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Risks of MIS XLIF

​Most XLIF surgeries can be performed safely without any complications.  However, like any surgical procedure there are risks associated with both the anaesthetic and the procedure itself.  

Risks of Anaesthesia

Risks of anaesthesia will be discussed with you by your anaesthetist prior to surgery.  It is important that you inform us of your correct age and any past medical problems, as this can influence the risk of anaesthesia.  Risks include:

• Heart problems, such as heart attack (AMI) or arrhythmia  
• Lung problems,  such as infection (pneumonia) or blood clots
• Urinary tract infection
• Deep Venous Thrombosis (DVT)
• Eye or visual problems
• Pressure wounds
• Stroke
• Small risk of significant life-threatening event

General Risks of Spine Surgery

Although spine surgery is generally safe, there are some risks whenever operations  on the spine are performed.  These include:

• Infection 1-2%
• Bleeding.  This can occur at the time of surgery and may necessitate a blood transfusion.  It can also occur at some time after surgery.  Rarely another operation is required to drain the bloodclot and stop the bleeding.  
• Spine fluid leak (CSF leak)
• Small risk of significant neurological injury causing paralysis
• Chronic pain

Specific Risks of XLIF

The specific risks will be discussed in detail prior to your surgery but may include:

• Pain in the lower back
• Nerve injury causing pain, numbness, weakness in the legs
• Femoral nerve palsy
• Numbness in the leg'
• Hip weakness
• Nerve injury causing bowel or bladder problems
• Progressive deformity of the lumbar spine - kyphosis or spondylolisthesis
• Requirement for fusion at later stage
• Incomplete decompression of posterioor pathology (unable to reach the back of spine)​
• Persistant symptoms
• Recurrence of symptoms
• Adjacent segment disease - problems at spine levels next to the fused level
• Non union - fusion not occurring
• Abdominal viscera injury Injury - bowel injury
• Vascular Injury - arterial or venous
• Ureteric injury
• Retrograde ejaculation
• Requirement for second procedure from the back of the spine