Are You a Candidate for XLIF Back Surgery?

Treating cervical radiculopathy

Most Americans, up to 80%, experience back pain at some point in their lives. Though chiropractic care, the branch of medicine dealing with disorders of the neuromusculoskeletal system, typically uses spinal adjustment to treat back pain, for some it is not enough. Acute and sub acute lower back pain, lasting anywhere from one to 12 weeks, can usually be corrected through such adjustments, but chronic pain lasting more than 12 weeks sometimes requires more extreme measures.

What is XLIF Back Surgery?

One type of back surgery is known as XLIF back surgery with “xlif” standing for eXtreme Lateral Interbody Fusion. The XLIF procedure involves the fusion of the lumbar spine from the side and can be used to treat certain lumbar spinal disorders. Conditions that can be treated by XLIF back surgery include:

  • lumbar degenerative disc disease.
  • spondylolisthesis.
  • scoliosis.
  • lumbar deformity.
  • recurrent lumbar disc herniations.
  • certain types of lumbar stenosis.

It cannot treat conditions at the lowest level at the spine, so it is not necessarily the only scoliosis surgery option available.

XLIF back surgery is considered a minimally invasive back surgery that is supposed to accomplish spinal fusion with several advantages. XLIF back surgery minimizes tissue damage and blood loss, creates only small scars and incisions, causes little post operative discomfort, and requires very little recovery time.

How is XLIF Back Surgery Performed?

XLIF back surgery is performed in a series of steps.

  1. Patient lies on his or her side. The surgeon locates the disc to be removed using an X ray.
  2. The surgeon marks the skin with a marker directly above the disc.
  3. The surgeon makes a small incision in the low back and uses his or her finger to push away the peritoneum, the sac covering the abdominal organs, away from the abdominal wall.
  4. A second incision is made on the side of the patient.
  5. The surgeon inserts a tube like instrument called a dilator into the second incision.
  6. X rays are used to make sure that the dilator is well placed.
  7. The surgeon inserts a probe through the psoas muscle which runs from the lower spine, wraps around the pelvic area, and attaches at the hip.
  8. A retractor tool is placed which allows the surgeon direct access to the spine.
  9. The offending disc is removed through a standard discectomy.
  10. The surgeon inserts the implant through the same incision. It helps hold the vertebrae in the proper position. This spacer, together with the bone graft, sets up an optimal environment for spine fusion.
  11. The surgeon closes and uses an X ray to make sure that the spacer is placed correctly.
  12. Additional implants like screws, plates, and rods are sometimes placed for extra support.

The procedure generally takes about an hour to perform.


XLIF back surgery should not be performed to fuse the space between the fifth lumbar and first sacral vertebrae, on patients with a low riding L4 to L5 level, on deformities involving significant rotation, to treat high grade spondylolisthesis, or where there is bilateral retropertonial scarring from a previous procedure.

Possible risks and complications include:

  • Persistent pain
  • Failure to fuse
  • Infection
  • Muscle weakness
  • Vascular injury
  • Neurologic injury
  • Urinary tract infection
  • Stroke
  • Pneumonia
  • Deep vein thrombosis
  • Persistent pain at the site of the bone graft harvest
  • Further progression of existing spinal disease

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