15 things to know about lateral spine surgery


Lateral spine surgery continues to be a game-changing procedure for many surgeons, yielding enhanced patient outcomes.

Here are 15 insights into the lateral spine surgery space.


1. Lateral lumbar interbody fusion is designed to treat spondylolisthesis, lumbar degenerative disc disease, scoliosis and recurrent lumbar disc herniation.

2. Minimally invasive lateral lumbar interbody fusion is gaining popularity, due to outcomes involving enhanced spine alignment, less blood loss and less tissue damage, according to a Transparency Market Research analysis.

3. The spine industry is witnessing a trend toward oblique lumbar interbody fusion and lateral lumbar interbody fusion and away from minimally invasive posterior lumbar interbody fusion and transforaminal lumbar interbody fusion devices, according to iData Research.

4. The U.S. lateral lumbar interbody fusion market is set to grow at a compound annual growth rate of 7.05 percent through 2020, according to a ResearchMoz study.

5. Key players in the lateral lumbar interbody fusion market include NuVasive, DePuy Synthes, Stryker, Smith & Nephew, Medtronic, Paradigm Spine and Alphatec Spine.

6. NuVasive developed the eXtreme Lateral Interbody Fusion approach in 2003, and surgeons have performed more than 150,000 successful XLIF procedures to date. Supported by more than 350 published clinical studies, XLIF has been shown to:


• Reduce operating time
• Lessen blood loss
• Reduce postoperative pain
• Cut recovery time
• Shorten length-of-stay


In March 2017, the United Kingdom's National Institute for Health and Care Excellence updated guidance for lateral interbody fusion. NICE reported evidence proving lateral interbody fusion efficacy is "adequate in quality and quantity." The institute received peer-reviewed journal articles outlining 14 years of investigation into NuVasive's XLIF procedure.

7. By April 12, Inspired Spine reported surgeons had performed more than 500 Oblique Lateral Lumbar Interbody Fusions — a minimally invasive procedure using an incision of 15 mm and incurring 80 percent less blood loss compared to a traditional fusion. A study published in Cureus found OLLIF saved hospitals an average of $9,500 per case compared to transforaminal lumbar interbody fusion.

8. Researchers compared concave and convex approaches in lateral lumbar interbody fusion for scoliosis correction, and presented the data at the 2016 Society of Minimally Invasive Spine Surgery Annual Forum. Of the 63 patients who underwent MIS reconstruction, 40 received the concave approach and 23 received the convex approach.


The researchers concluded, "Patients undergoing cMIS surgery for adult degenerative scoliosis had equivalent complication rates, clinical and operative, with concave or convex LLIS approaches."

9. A study published in Spine investigated single-level lateral lumbar interbody fusion for patient suffering from adjacent segment disease. The 52 LLIF patients experienced reduced back and leg pain, increased segmental lordosis and decreased segmental coronal angulation. Researchers also discovered increased intervertebral height at the surgical level. The study noted a 21.2 percent reoperation rate.


Researchers concluded LLIF "may be an effective surgical treatment option for ASD with regard to both the clinical and radiographic outcomes in a large portion of cases."

10. Researchers analyzed the effect of transformational lateral interbody fusion on patients undergoing surgery for one-level lumbar degenerative spondylolisthesis with the posterior approach. The study compared 30 patients undergoing isolated instrumented posterior fusion to 30 patients receiving the associated instrumented posterior fusion and transformational lumbar interbody fusion approach.


The study revealed significant improvement in pain and disability among patients in both groups. Based on radiographic assessment, the posterolateral fusion rate proved better for the TLIF patients. The results showed TLIF isn't mandatory for the degenerative spondylolisthesis indication.

Surgeon thoughts
11. Frank La Marca, MD, chief of University of Michigan Health System's department of neurosurgery, spine section, told Becker's minimally invasive lateral approach techniques have contributed to the advancement of spinal surgery over the last decade.


"These surgical techniques, such as lateral interbody arthrodesis with or without anterior longitudinal ligament release, are not new per se but thanks to the introduction of minimally invasive approaches have become more accessible to a broader number of surgeons and often eliminated the need for an assistant surgeon to help in the surgical exposure."

12. James J. Lynch, MD, founder of Reno-based SpineNevada, told Becker's the lateral lumbar spine approach is the "single most influential technique" introduced in the last 10 years.


He argued no other procedure has enhanced "patient wellbeing by minimizing the approach to fusion techniques and certainly changing the way surgeons address global alignment strategies and overall sagittal balance issues by avoiding more outdated, scoliosis, open, destructive surgical procedures."

13. Brian R. Gantwerker, MD, of The Craniospinal Center of Los Angeles, told Becker's the lateral interbody technique changed his practice: "It has allowed us to look at the spine as a true three-dimensional construct and to start really thinking about how to change coronal and some sagittal issues."

14. Edward H. Scheid Jr., MD, president and founder of Capital Region Neurosurgery & President, Capital Region Special Surgery in Slingerlands, N.Y., said minimally invasive lateral interbody fusion techniques changed how spine care is delivered.


"By allowing a surgeon to correct coronal imbalance with lateral grafts placed via a minimal approach, XLIF and other lateral fusion techniques have opened up an opportunity to treat patients more effectively, and allow fusions to be performed without long incisions and large posterior constructs," he told Becker's.

15. Vladimir Sinkov, MD, of Nashua-based New Hampshire Orthopaedic Center, noted the lateral lumbar interbody fusion with direct visualization of the psoas has offered the least invasive approach for fusing the thoracolumbar spine safely.


"My outcomes have improved [and] length of hospital stay has decreased. I can offer this surgery to patients who would not be able to tolerate the traditional open lumbar fusion due to their health, anatomy or history of previous spine procedures," he told Becker's.

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