What is Lateral Access Surgery?

Lateral access is a safe and reproducible means of addressing certain spine disorders with an approach from the side of the patient, as opposed to an approach from the back (posterior) or the front (anterior). A lateral (side) approach is made safe with the use of nerve monitoring technology (NeuroVision^® from NuVasive^®, Inc.).

XLIF^®: A New Avenue for Treatment

The XLIF (eXtreme Lateral Interbody Fusion) procedure provides relief to patients who cannot tolerate a larger, open back surgery because of the increased risks of longer anesthesia time, blood loss, hospitalization, and recovery. It is also a less disruptive alternative for patients who have lived with back or leg pain through years of various failed treatments, including steroid injections, physical therapy, and pain medication.

The XLIF procedure includes the use of NeuroVision, a technologically advanced nerve monitoring system (EMG), allows the surgeon to have accurate, reproducible, real-time feedback about nerve health, location, and function, reducing the incidence of nerve injury during surgery. Read more about NeuroVision and the importance of nerve monitoring. »

Patient Benefits

• Reduced operative time – Traditional procedures can take up to 5 hours; the XLIF procedure can be successfully completed in as little as one hour, reducing the amount of anesthesia time.
• Reduced blood loss and minimal scarring – Less-disruptive procedure allows for less tissue disruption, resulting in reduced blood loss.
• Reduced postoperative pain – The XLIF procedure does not require entry through sensitive back muscles, bones, or ligaments.Many patients are usually walking the same day after surgery.
• Reduced hospital stay – Patients are typically walking the same day after surgery and require only an overnight stay in the hospital, compared to several days of immobility and hospitalization typical of traditional open approaches
• Rapid return to normal activity – Patients are usually walking the same day after surgery. Recovery is typically around 6 weeks, compared to 6 months or more.

Risks specific to any lumbar spinal surgery include, but are not limited to: revision or reoperation, change in lordosis, injuries to kidneys or ureters, deterioration in neurological status, facet joint deterioration, spondylolysis, spondylosis, spondylolisthesis, nerve damage due to surgical trauma, neurological difficulties including bowel and/or bladder dysfunction, retrograde ejaculation, tethering of nerves in scar tissue, muscle weakness or paresthesia, vascular damage including hematoma, ileus injuries, deep vein thrombosis potentially leading to pulmonary embolism, catastrophic or fatal bleeding, dural tears experienced during surgery resulting in the need for further surgery for dural repair, a chronic CSF leak or fistula, and possible meningitis, bursitis, paralysis, damage to lymphatic vessels and/or lymphatic fluid exudation, fracture of bony structures, anesthetic reaction, bowel perforation, hernia, infection-peritonitis, periotoneal adhesions, failure of the procedure to improve symptoms and/or functions, spinal stenosis, and death.

The XLIF minimally disruptive procedure can be performed for a number of situations. The list below contains representative examples. The list is not intended to include all possible indications and/or contraindications.

Any thoracolumbar case above L5-S1 requiring access to the disc space and/or vertebral bodies. Examples include:

• DDD with Instability
• Recurrent Disc Herniation
• Degenerative Spondylolisthesis (≤ grade 2)
• Degenerative Scoliosis
• Pseudoarthrosis
• Discitis, Vertebral Osteomyelitis (without active infection)
• TDR Revision
• Post-Laminectomy Instability
• Junctional Disease

Any generally accepted contraindication to fusion such as:

• Systemic infection
• Osteoporosis
• Significant co-morbidities
• L5-S1
• Lumbar deformities with > 30° rotation
• Degenerative spondylolisthesis > grade 3
• Bilateral retroperitoneal scarring (e.g., abscess or prior surgery)
• Need for direct posterior decompression through same approach
  (Second posterior micro-decompression not contraindicated)
  

It is important that you discuss the potential risks, complications, and benefits of XLIF^® with your doctor prior to receiving treatment, and that you rely on your physician's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.

The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the relationship that you have with your healthcare professional. We do not practice medicine or provide medical services or advice as a part of this Web site. You should always talk to your healthcare professional for diagnosis and treatment. Please use the Physician Locator on www.lateralaccess.org to find a SOLAS^® surgeon in your area.

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