What Is XLIF?

Thanks to breakthroughs in spinal medicine, patients today can benefit from treatment regimens and procedures tailored to their individual needs and specific conditions. Among these recent advances on the surgical front is eXtreme Lateral Interbody Fusion, or XLIF.

What is XLIF Spine Surgery?

XLIF refers to a type of spine fusion surgery. In this procedure, the surgeon reaches the spinal disc from the side of the body, which is known as a lateral approach. This is unlike other methods, which access the spine anteriorly (from the front of the body) or posteriorly (from the back of the spine)

For patients suffering from symptoms of spinal conditions, XLIF spine surgery is to assuage nerve root compression in the spine, correct spinal deformities, and resolve spinal instability. 

XLIF Procedure Process

XLIF is among the endoscopic spine surgery procedures performed with microsurgery tools and techniques. It’s generally performed with general anesthesia, so the patient is asleep through the procedure. Additionally, XLIF takes about an hour to complete. 

Electromyography in XLIF

Nerves extending from the backbone are positioned near the psoas, which can be compromised during surgery. To avert nerve damage, the XLIF procedure utilizes electromyography (EMG), a type of neuromonitoring. This enables the surgeon to examine the nerves that emerge out of the spine throughout the procedure, making sure that they’re not inflamed or damaged.


XLIF falls into the category of back surgery involving the removal of the disc in the front of the spine. Then, an implant that holds a bone graft is used to replace the disc. The graft enables the two vertebrae to fuse between the disc area in a process known as spinal fusion.

For patients with chronic back pain, XLIF provides a method of spinal fusion for the treatment of several different lower back disorders.

Steps of XLIF

  1. The first step of XLIF surgery is to put the patient under general anesthesia. 
  2. Next, with the patient positioned on one side of the body, the surgeon will take x-rays. Using the information gathered from these x-rays, the surgeon can define the exact position of the intervertebral disc that will be extracted. 
  3. With the position of the disc marked on the patient’s skin, the surgeon will create an incision in the patient’s flank. The flank is located in between the hips and lower ribs. 
  4. Next, the surgeon will adjust the peritoneum aside from the abdominal wall. The peritoneum protects and encompasses the organs of the abdomen. 
  5. The surgeon will then make a second incision in the side of the body. A dilator will be placed into the incision, and the position of the dilator is checked with an x-ray. The dilator should be positioned precisely above the intervertebral disc. 
  6. To gain access to the spine, the surgeon will use a probe to separate the psoas. Then, a retractor can be used to allow spinal access. 
  7. With a path to the spine, the surgeon will remove the nucleus (interior) of the affected intervertebral disc. This step, which is referred to as discectomy, preps the area for fusion. 
  8. A spacer containing bone graft material will then be placed into the disc area. The spacer maintains the position of the vertebrae and helps with the fusion process. 
  9. In some cases, the surgeon may opt to complete posterior fixation with rods and facet/pedicle screws. This step can provide spinal stability after XLIF surgery. 

How Does XLIF Differ From Conventional Spine Procedures?

XLIF differs from the traditional posterior approach for spine surgery, which is called posterior interbody fusion (PLIF). Since PLIF involves reaching the spine from the back, the procedure requires the surgeon to disturb the large back muscles. Doing so triggers a lengthy recovery process, along with significant pain in the post-op period. 

Additionally, XLIF is a minimally-invasive form of spine surgery, unlike PLIF. Along with a shorter recovery period and less postoperative discomfort, minimally-invasive procedures offer the benefit of a lower risk for medical conditions.  

What Are The Benefits of XLIF?

  • Requiring only small incisions, XLIF surgery minimizes tissue damage, blood loss. and scarring. 
  • XLIF has a relatively quick recovery time, especially when compared to conventional spine surgery.
  • Taking as little as an hour to complete, XLIF minimizes the amount of time that the patient spends under anesthesia. 
  • Since the back muscles, ligaments, and bones are left undisturbed with the lateral approach of XLIF, patients experience less pain. 
  • After XLIF, patients can return to their regular activities faster than through conventional spine surgery. 
  • Patients can often walk on the day of the XLIF procedure. 
  • Although some XLIF cases may require the patient to stay for one night at the hospital, it typically results in a quicker hospital stay than other spinal procedures. After conventional spinal fusion, patients must remain in the hospital for multiple days after the procedure. 
  • XLIF surgery reviews are positive and indicate that the procedure can successfully reconstruct spinal deformities. 

What Are The Drawbacks of XLIF?

A drawback of the XLIF procedure is that it involves fusing vertebrae. Spinal fusion eliminates independent movement between adjacent levels.

Spinal fusion significantly lengthens the recovery period of any spinal fusion procedure. Unfortunately, even after making a full recovery, patients won’t regain a full range of motion in the spine. With each vertebra that’s fused, patients lose a degree of spinal flexibility. 

After XLIF with spinal fusion, patients may no longer be able to bend, flex, stretch, and twist the back like they once could. This can diminish patients’ ability to partake in various physical activities. 

Additionally, when two or more vertebrae are fused, they force the rest of the spine to compensate for their lack of motion. Specifically, the vertebrae on top of and below the fused spinal bone undergo increased impact. This can result in adjacent segment disease, or ADA.

With ADA, the vertebrae that are adjacent to the fused portion of the spine degenerate more rapidly. This can result in chronic back pain and neurological symptoms in the legs and feet. 

Fusion Alternatives

Non-Surgical Treatment Methods

Spinal fusion typically isn’t recommended until patients have undergone several months of conservative treatments. Nonetheless, patients looking to avoid the complications of fusion may consider continuing with non-surgical therapies, such as:

  • Physical therapy

Physical therapy can help patients improve their posture, strengthen the spine’s supporting muscles, and alleviate muscle tension. 

  • Chiropractic care

Chiropractic care can help relieve tension in the spine by enhancing spinal alignment. 

  • Lifestyle modifications and rest

Rest and lifestyle modifications can reduce the strain on the spine. Lifestyle factors including smoking, having a sedentary lifestyle, and having a high body weight can exacerbate spinal conditions.  

  • Anti-inflammatory medications

Anti-inflammatory medications can help patients manage chronic pain from spine conditions. NSAIDs, muscle relaxants, and acetaminophen are examples of medications that may benefit patients with chronic spinal pain. 

  • Epidural steroid injections

Epidural steroid injections can only be used a few times per year. However, this condition can help alleviate pain and swelling from spinal disorders. 

Spinal Implants

Today, thanks to another advance in spinal medicine – the TOPS™ System –  some patients may be able to avoid the risks and complications associated with spinal fusion. In select cases, a TOPS implant can be used in place of traditional spine fusion surgery to resolve conditions such as spinal stenosis, spondylolisthesis, and herniated discs. 

Unlike fusion, the TOPS System preserves the full range of motion of individual vertebrae. Additionally, the TOPS System has been proven to provide better outcomes than spinal fusion in clinical studies conducted around the world. This adds up to two breakthroughs in the treatment of spinal conditions, promising effective relief for many patients with back problems that require a surgical solution.

With the TOPS System, patients can avoid:

  • The lengthy recovery period associated with fusion
  • The post-operative pain that patients experience with fusion
  • The prolonged hospital stay required after fusion
  • The reduced spinal mobility caused by fusion
  • The risk of adjacent segment disease and related conditions

If you’re struggling with symptoms of a spinal disorder, talk to your doctor about the available treatment options, such as XLIF surgery and the TOPS System.