XLIF – A New Technique of the Lumbar Vertebra Replacement: Initial Experience

Czech version

Authors: L. Hrabálek; T. Wanek; M. Adamus ^*
Authors‘ workplace: Neurochirurgická klinika FN a LF UP Olomouc ; Klinika anesteziologie a resuscitace FN a LF UP Olomouc ^*
Published in: Rozhl. Chir., 2010, roč. 89, č. 12, s. 784-788.
Category: Monothematic special - Original

Overview

Extreme lateral interbody fusion (XLIF) is a novel technique for the anterior disc replacement. The aim of this report was description of the surgical technique of XLIF. Based on our experience with first eleven patients we report advantages and drawbacks of this method. Patients who presented with symptomatic degenerative disc disease or failed back surgery syndrome were considered candidates for this surgery. The patient was placed in a true right lateral decubitus position and small (6 cm) left lateral skin incision was performed. Access to the lumbar spine was achieved by approach that passes through the retroperitoneally fat and psoas major muscle, using peroperative fluroscopy. Expandable retractor was inserted, discectomy and replacement by Oracle (Synthes, USA) cage (with synthetic cancellous bone graft) to the interbody space was performed. XLIF represents save surgical method with maximally careful approach and spacious working portal. The new benefit of XLIF is based on the minimally invasive spine surgery technique through retroperitoneal space. The lateral access to the disc avoids the major vessels and nerves and implant placement in the anterior and bilateral position provides sagital and coronal plane imbalance correction.

Key words:
lumbar spine – degenerative disc disease – minimally invasive approach – XLIF – interbody fusion

Sources

1. Obenchain, T. E. Laparoscopic lumbar discectomy: case report. J. Laparoendosc. Surg., 1991; 1: 145–149.

2. Shen, F. H., Samartzis, D., Khanna, A. J., Anderson, D. G. Minimally invasive techniques for lumbar interbody fusions. Orthop. Clin. N. Am., 2007; 38: 373–386.

3. McAfee, P. C., Regan, J. J., Geis, W. P., Fedder, I. L. Minimally invasive anterior retroperitoneal approach to the lumbar spine. Emphasis on the lateral BAK. Spine, 1998; 23: 1467–1484.

4. Hrabálek, L., Bučil, J., Vaverka, M., Houdek, M., Krahulík, D., Kalita, O. Indikace přední náhrady meziobratlové ploténky u zlomenin hradní a bederní páteře s využitím magnetické rezonance – prospektivní studie. Cesk. Slov. Neurol. N., 2009; 72/105 (2): 132–140.

5. Hrabálek, L., Rešková, I., Bučil, J., Vaverka, M., Houdek, M. Použití titanových a PEEKových implantátů při ALIF stand-alone u degenerativního onemocnění lumbosakrální páteře – prospektivní studie. Cesk. Slov. Neurol. N., 2009; 72/105 (1): 38–44.

6. Pimenta, L. Lateral endoscopic transpsoas retroperitoneal approach for lumbar spině surgery. Paper presentation at the VIII. Brazilian Spine Society Meeting. Belo Horizonte, Minas Gerais, Brazil, May, 2001.

7. Bergey, D. L., Villavicencio, A. T., Goldstein, T., Regan, J. J. Endoscopic lateral transpsoas approach to the lumbar spine. Spine, 2004; 29(15): 1681–1688.

8. Ozgur, B. M., Aryan, H. E., Pimenta, L., Tailor, W. R. Extreme Lateral Interbody Fusion (XLIF): a surgical technique for anterior lumbar interbody fusion. The Spine Journal, 2006; 6: 435–443.

9. Kočiš, J., Wendsche, P., Višňa, P., Mužík, V. Méně invazivní retropleurální – retroperitoneální přístup k torakolumbální páteři. Acta Chir. orthop. Traum. cech., 2002; 69: 285–287.

10. Kleeman, T. J., Michael Ahn, U., Clutterbuck, W. B., Campbell, C. J., Talbot-Kleeman, A. Laparoscopic anterior lumbar interbody fusion at L4-L5: an anatomie evaluation and approach classification. Spine, 2002; 27(13): 1390–1395.

11. Moro, T., Kikuchi, S., Konno, S., Yaginuma, H. An anatomie study of the lumbar plexus with respect to retroperitoneal endoscopic surgery. Spine, 2003; 28(5): 423–428.

12. Bengli, D. M., Vanni, S., Levi, A. D. An anatomical study of the lumbosaeral plexus as related to the minimally invasive transpsoas approach to the spine. J Neurosurg. Spine, 2009; 10(2): 139–144.

13. Knight, R. Q., Schwaegler, P., Hanscom, D., Roh, J. Direct lateral lumbar interbody fusion for degenerative conditions: early complication profile. J Spinal Disord. Tech., 2009; 22(1): 34–37.

14. Bose, B., Wierzbowski, L. R., Sestokas, A. K. Neurophysiologic monitoring of spinal nerve root function during instrumented posterior lumbar spine surgery. Spine, 2002; 27(13): 1444–1450.

15. Dakar, E., Cardova, R. F., Smith, D. A., Uribe, J. S. Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurg. Focus, 2010; 28(3): E8.