Lateral lumbar interbody fusion, also known as extreme lateral interbody fusion, is a relatively new procedure that surgeons have found successful for treating patients with complex disorders such as spondylolisthesis and scoliosis. "Right now, I consider lateral lumbar interbody fusions to be the most successful procedure to accomplish what we set out to do in terms of surgical interventions for these complex procedures," says Frank Cammisa, MD, chief of spine service for the Hospital for Special Surgery in New York City. He discusses four points on the XLIF procedure.
1. Performing XLIF procedures. XLIF is a minimally invasive procedure where the surgeon makes an incision in the patient's side and accesses the spine laterally through the psoas muscle, referred to as the "trans-psoas" approach. Once the incision is made, a special tubular retractor is inserted and dilated. The lumbar plexus goes through the psoas and surgeons use neuromonitoring to identify the nerves. "We want to make sure we are between the nerves so we don't damage them," says Dr. Cammisa. "We're able to do complete corpectomies without making large flank incisions and damaging the patient's anatomy. It's a much less traumatic experience for patients, which really helps them mentally as well as physically."
Once the equipment is in place, surgeons can use cages filled with bone growth factors to achieve fusion. Iliac bone graft can also be used, but this technique is falling out of fashion. "It's rare that I ever have to take a bone graft from the iliac crest," says Dr. Cammisa. "It just saves so much time and avoids patient pain when you don't have to take a graft from the patient."
2. Benefits of XLIF. Dr. Cammisa is able to perform complex surgeries, such as an adult degenerative scoliosis correction, through a smaller incision fusing fewer levels than with the open posterior approach. Less invasive procedures are beneficial because they allow a surgical intervention without significant blood loss or muscle and tissue damage and patients with decreased hospital stays are able to begin rehabilitation quicker than with the traditional open procedure. When patients are able to rehabilitate quicker, they are able to return to work sooner.
3. Incorporating lateral lumbar interbody fusion into your practice. There are many device companies that now offer lateral lumbar interbody fusion devices, led by NuVasive's eXtreme Lateral Interbody Fusion. Surgeons can undergo training courses with their device of choice and then observe surgeons who are already proficient with the procedure. "It is less complicated for the surgeon if they are able to start performing a procedure without a steep learning curve," says Dr. Cammisa. "Most experienced surgeons will be able to pick it up very quickly, incorporate it into their practice and be very happy with it."
4. Will it stick around in the future? The XLIF has a typical learning curve of a new spine procedure, but unlike other minimally invasive technologies, Dr. Cammisa sees it becoming more of a standard-of-care in the future. "I think it's going to be used very regularly by spine surgeons all over the country and the world," he says. "Other minimally invasive procedures won't stand the test of time because the outcomes won't be as good as people think they are. This type of procedure is different because it accomplishes the same goals as the traditional surgery through a less invasive approach."
Learn more about Dr. Frank Cammisa.
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1. Performing XLIF procedures. XLIF is a minimally invasive procedure where the surgeon makes an incision in the patient's side and accesses the spine laterally through the psoas muscle, referred to as the "trans-psoas" approach. Once the incision is made, a special tubular retractor is inserted and dilated. The lumbar plexus goes through the psoas and surgeons use neuromonitoring to identify the nerves. "We want to make sure we are between the nerves so we don't damage them," says Dr. Cammisa. "We're able to do complete corpectomies without making large flank incisions and damaging the patient's anatomy. It's a much less traumatic experience for patients, which really helps them mentally as well as physically."
Once the equipment is in place, surgeons can use cages filled with bone growth factors to achieve fusion. Iliac bone graft can also be used, but this technique is falling out of fashion. "It's rare that I ever have to take a bone graft from the iliac crest," says Dr. Cammisa. "It just saves so much time and avoids patient pain when you don't have to take a graft from the patient."
2. Benefits of XLIF. Dr. Cammisa is able to perform complex surgeries, such as an adult degenerative scoliosis correction, through a smaller incision fusing fewer levels than with the open posterior approach. Less invasive procedures are beneficial because they allow a surgical intervention without significant blood loss or muscle and tissue damage and patients with decreased hospital stays are able to begin rehabilitation quicker than with the traditional open procedure. When patients are able to rehabilitate quicker, they are able to return to work sooner.
3. Incorporating lateral lumbar interbody fusion into your practice. There are many device companies that now offer lateral lumbar interbody fusion devices, led by NuVasive's eXtreme Lateral Interbody Fusion. Surgeons can undergo training courses with their device of choice and then observe surgeons who are already proficient with the procedure. "It is less complicated for the surgeon if they are able to start performing a procedure without a steep learning curve," says Dr. Cammisa. "Most experienced surgeons will be able to pick it up very quickly, incorporate it into their practice and be very happy with it."
4. Will it stick around in the future? The XLIF has a typical learning curve of a new spine procedure, but unlike other minimally invasive technologies, Dr. Cammisa sees it becoming more of a standard-of-care in the future. "I think it's going to be used very regularly by spine surgeons all over the country and the world," he says. "Other minimally invasive procedures won't stand the test of time because the outcomes won't be as good as people think they are. This type of procedure is different because it accomplishes the same goals as the traditional surgery through a less invasive approach."
Learn more about Dr. Frank Cammisa.
Related Articles on Spine Surgery:
Dr. James Lynch: The Next 5 Years of Spine Surgery
Dr. Joan O'Shea: How to Achieve Great Results for Spine surgery in an ASC
5 Things to Know About the Use of Stem Cells in Spine Surgery