Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012:2012:246989.
doi: 10.1100/2012/246989. Epub 2012 Nov 1.

Clinical outcome and fusion rates after the first 30 extreme lateral interbody fusions

Gregory M Malham  1 , Ngaire J Ellis, Rhiannon M Parker, Kevin A Seex
Affiliations

Clinical outcome and fusion rates after the first 30 extreme lateral interbody fusions

Gregory M Malham et al. ScientificWorldJournal. 2012.

Abstract

Introduction: The lateral transpsoas approach for lumbar interbody fusion (XLIF) is gaining popularity. Studies examining a surgeon's early experience are rare. We aim to report treatment, complication, clinical, and radiographic outcomes in an early series of patients.

Methods: Prospective data from the first thirty patients treated with XLIF by a single surgeon was reviewed. Outcome measures included pain, disability, and quality of life assessment. Radiographic assessment of fusion was performed by computed tomography.

Results: Average follow-up was 11.5 months, operative time was 60 minutes per level and blood loss was 50 mL. Complications were observed: clinical subsidence, cage breakage upon insertion, new postoperative motor deficit and bowel injury. Approach side-effects were radiographic subsidence and anterior thigh sensory changes. Two patients required reoperation; microforaminotomy and pedicle screw fixation respectively. VAS back and leg pain decreased 63% and 56%, respectively. ODI improved 41.2% with 51.3% and 8.1% improvements in PCS and MCS. Complete fusion (last follow-up) was observed in 85%.

Conclusion: The XLIF approach provides superior treatment, clinical outcomes and fusion rates compared to conventional surgical approaches with lowered complication rates. Mentor supervision for early cases and strict adherence to the surgical technique including neuromonitoring is essential.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Abdominal axial computed tomography (CT) showing intraperitoneal free air following unrecognized bowel perforation.
Figure 2
Figure 2
Change in minimum, maximum, and average low back pain (LBP) from preoperative to last followup (mean 11.5 months).
Figure 3
Figure 3
Change in minimum, maximum, and average leg pain (LP) from preoperative to last followup (mean 11.5 months).
Figure 4
Figure 4
Change in average disability (ODI), and physical and mental quality of life (PCS and MCS) from preoperative to last followup (mean 11.5 months).
Figure 5
Figure 5
Coronal computed tomography (CT) showing solid arthrodesis at 12 months postoperative following L4-5 XLIF.
See this image and copyright information in PMC

References

    1. Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine Journal. 2006;6(4):435–443. - PubMed
    1. Shamji MF, Isaacs RE. Anterior-only approaches to scoliosis. Neurosurgery. 2008;63(supplement 3):A139–A148. - PubMed
    1. Sharma AK, Kepler CK, Girardi FP, Cammisa FP, Huang RC, Sama AA. Lateral lumbar interbody fusion: clinical and radiographic outcomes at 1 year: a preliminary report. Journal of Spinal Disorders and Techniques. 2011;24(4):242–250. - PubMed
    1. Rodgers WB, Gerber EJ, Patterson JR. Fusion after minimally disruptive anterior lumbar interbody fusion: analysis of extreme lateral interbody fusion by computed tomography. SAS Journal. 2010;4(2):63–66. - PMC - PubMed
    1. Baker JK, Reardon PR, Reardon MJ, Heggeness MH. Vascular injury in anterior lumbar surgery. Spine. 1993;18(15):2227–2230. - PubMed