Complications in Extreme Lateral Interbody Fusion (XLIF®): A Retrospective Study in Siriraj Hospital

Background: Extreme Lateral Interbody Fusion (XLIF®) is a well-known transpsoas approach technique that confers advantages including excellent visualization, easy access to the lumbar disc, accommodation for a large anterior graft, restoration of disk height and lumbar alignment, and indirect decompression. However, no study in Thailand has investigated early postoperative complications after spinal fusion with XLIF surgery. Objective: To determine the early postoperative complication rates among Thai patients that underwent spinal fusion with XLIF procedure. Materials and Methods: The present study was a retrospective chart review to evaluate perioperative and early postoperative complications in patients that underwent spinal interbody fusion with XLIF procedure and were followed-up for a minimum of three months at the Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand between 2015 and 2019. Results: One hundred eighteen patients, including 82 females and 36 males, with a mean age of 64.2 years and 165 levels, that were operated upon, were included. Eighty patients (67.8%) underwent one-level fusion, 29 (24.6%) had two-level fusion, and 9 (7.6%) underwent three-level fusion. Immediate postoperative complications occurred in 66 patients (55.9%), consisting of eight (6.7%) with medical complications, 57 (48.3%) with surgical complications, and one (0.8%) with combined medical and surgical complications. Postoperative complications were resolved within three months after surgery in 48 patients. Forty-one patients (34.7%) had postoperative proximal lower limb neuropathy. Only 10 patients (24.4%) still had neuropathy at the 3-month follow-up, but it did not affect their function. Conclusion: Postoperative proximal limb neuropathy, including thigh numbness, pain, or hip flexor weakness, had a high prevalence in the present study despite intraoperative neurophysiologic monitoring; however, most cases resolved by the 3-month follow-up. Patient education about potential nerve irritation complication is recommended, and meticulous preoperative radiographic assessment and careful step-by-step intraoperative surgical approach may reduce the rates of these postoperative complications. Keywords: Extreme lateral interbody fusion; Complications; Neuropathy; Postoperative

Advancements in Minimally Invasive Lateral Interbody Fusion

Extreme lateral interbody fusion (XLIF) is a popular surgical technique to address a wide variety of spinal pathologies. The purpose of this chapter is to explore the XLIF procedure, including indications for its use, post-fusion operative outcomes, intraoperative considerations, and advantages and disadvantages over similar fusion techniques.

Extreme lateral interbody fusion (XLIF) in a consecutive series of 72 patients

Extreme lateral interbody fusion (XLIF) has become the standard of minimally invasive lumbar segmental scoliosis treatment. Our objective is to determine the safety and efficacy of XLIF in spinal canal stenosis (SCS) and spondylodiscitis (SD). Patients treated with XLIF in our department between 2012 and 2018 were retrospectively analyzed. Patient records with clinical and radiographical parameters were evaluated. The patient cohort consists of 40 male and 32 female patients with a median age of 66.6 years. Forty-five patients had an SCS and 27 patients SD. The mean follow-up was 23 months. One level XLIF was performed in 49 patients, 2 levels in 15, 3 levels in 7 patients and 4 levels in 1 patient. All but one patient received an additional dorsal stabilization. The pain was present in all patients with a mean Visual Analogue Scale (VAS) score of 8.8 vs. postoperative VAS of 2.8 (p<0.05). Preoperative neurological deficits were found in 44 patients. Only 6 patients had a neurological deterioration, 45 patients improved, and 21 patients remained unchanged. One patient experienced a perioperative complication. Non-fusion occurred in 8 cases. There were no outcome differences regarding pain and radiological outcome between patients with SCS and SD as well as between patients with one level vs. multilevel surgery. Baseline characteristics and the radiological outcome did not differ between the two groups. Patients with SD had a higher rate of worsening of neurological deficits following surgery, a higher rate of non-fusion, and a longer hospital stay. Patients with spinal canal stenosis SCS had a longer surgery time and more frequent adjacent segment disease.

Clinical experience of extreme lateral interbody fusion in the treatment of lumbar spondylodiscitis

Introduction Up to now, there were few studies on extreme lateral interbody fusion (XLIF) surgery for lumbar spondylodiscitis. This study was aimed to evaluate clinical effectiveness and provide more information for XLIF in the treatment of lumbar spondylodiscitis. Methods We retrospectively collected cases of XLIF for the treatment of lumbar spondylodiscitis from September 2017 to February 2020. There were 8 cases of non-specific infection of lumbar spine, 4 cases of lumbar tuberculosis, and 1 case of lumbar brucellosis. Basic information, antibiotic application, and inflammatory index were collected before and after surgery. Clinical effectiveness was evaluated at baseline and in 3, 6, and 12 months after the surgery with visual analog scale (VAS) and Oswestry disability index (ODI). The comparison of the indicators before and after the operation was performed by repeated measures analysis of variance. Results The average intraoperative blood loss and operation time was 70mL and 99.23 min, respectively. The study consisted of 13 cases with single segment operation. The average follow-up time was 16.54 months. No sign of recurrence of spondylodiscitis occurred at last follow-up. Postoperative VAS and ODI were significantly decreased after the operation. No major blood vessels, nerves, or organ damage occurred during the perioperative period. Conclusion XLIF has shown good clinical effectiveness in the treatment of lumbar spondylodiscitis with advantages of less bleeding and less tissue damage in the present study. More multi-center prospective comparative studies are needed to further verify the clinical effectiveness of this procedure in lumbar spondylodiscitis.