Extreme Lateral Lumbar Interbody Fusion (X-LIF)
The extreme lateral approach is a more recent innovation in lumbar fusion surgery and is performed with the patient lying on one side. Through a small incision approximately 8cms in length the surgeon accesses the side of the lumbar spine between the first and fourth lumbar vertebrae. The method is not suitable for the lowest level of lumbar spine at L5/S1, and sometimes not for L4/5 either, because the iliac crest (hip bone) gets in the way.
The disc removal and subsequent insertion of the fusion cage is performed through a split made in the Psoas muscle, which lies down the side of the lumbar spine. Using specially-designed instruments and retractors the surgeon locates the disc space from the side and can resect the disc and replace it with a PEEK (plastic) cage containing bone graft or Bone Morphogenetic Protein (BMP). In many cases pedicle screws must then be inserted through small incisions on the patient's back.
A minor variation on the direct lateral approach is the Anterior-to-Psoas approach. This is performed through the same skin incision as the X-LIF, but instead of performing the discectomy and insertion of the fusion cage through the Psoas muscle, the muscle is retracted, and the discectomy and insertion of the fusion cage performed in front of the muscle, rather than through the belly of the muscle as in X-LIF.
Dr. Brazenor will take a number of factors into consideration before recommending an X-LIF or ATP operation, including the condition to be treated, your age, health and lifestyle and your anticipated level of activity following surgery.
Dr. Brazenor will always explain your non-surgical option (if there is one) as well as the surgical option along with its success rate, failure rate and risks. Except when cancer or dangerous spinal instability is present, it is always Dr. Brazenor's advice that if you are then not sure about having surgery, you should choose not to have surgery for the moment. Stop, think, and let some time pass, and the correct way for you to manage your condition will become clear.