Dr. Raiszadeh describes eXtreme lateral interbody fusion (XLIF).
XLIF stands for eXtreme Lateral Interbody Fusion. So what we mean by that is you are going laterally, meaning through the side, and it’s extreme lateral because we are doing directly lateral, and the procedure involves moving the abdominal contents out of the way through the side incision.
And the incision on the side is maybe two inches long, and as we go down in, we split the muscle, and the benefit of this procedure to the muscle is that what you are doing is taking the muscle, and instead of disrupting it, you are putting a dilator in and then dilating over that.
So what happens is that you have your initial dilator, and then each subsequent dilator moves the muscle out of the way. We rotate these as we go down, and what that does is by moving those muscles out of the way, and you are not disrupting them, and they fall right back into place after you have done that.
So the procedure involves putting in initial dilator like this, and then what we do is we monitor this activity because we want to avoid those nerves that we discussed earlier. So as this goes down, this first dilator goes down, the monitoring that’s attached to muscles of the leg will tell us if we are near a nerve. And if we are near a nerve we change the position of the initial dilator.
So then when we finally get through this muscle and we dock on where we want to get to, that’s when we switch over and do the other dilator. So then we add the second dilator and do the same procedure.
As we are dilating this across, we dilate and monitor, and then when that goes down, the same procedure on the third one–dilate and then monitor. So, once we get down we put in our retractor, and then we have an incredibly vast exposure to that disc. And with that exposure to the disc we can use standard instruments to take out the disc, and these include grabbers like this where we can go in and can take out the disc fragments.
It includes other, other instruments which allow elevation of the disc space where you can go in and you can actually dilate that disc space up. So for disc space that is collapsed, this helps elevate that disc space up and take the pressure off the nerves.
Then we can put an implant in, and you see how big this implant is. It’s a very big implant because the disc is very big. Imagine the disc is very large; to get an implant to really fill the size of this disc, it has to be a big implant. We can put quite a large implant through this very small incision and fit it through the disc, and as you can see here--all the way down into the disc.
And so at the end of the day what we end up having is an implant like this where it goes across the disc space, fills it, is able to establish a stability and build up a height. And even through this small incision we can even add a plate. So this is what that would look like here, with the plate added on to the spine.
So it’s a very versatile procedure that allows excellent exposure to the disc, stability, disc height elevation, nerve decompression, as well as stability with both the implant as well as the plate.
About Dr. Raiszadeh, M.D.:
Kam Raiszadeh, MD, serves as medical director of the Advanced Spine Institute & Minimally Invasive Spine Center at Alvarado Hospital. Dr. Raiszadeh is board certified by the American Board of Orthopaedic Surgery and an active member of the Scoliosis Research Society and North American Spine Society.