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Procedural Comparison

Due to advances in medical technology, patients suffering from pain due to degenerative conditions now have more options than ever before. Each option has its own set of risks and benefits. Your doctor may first attempt to address your problem non-surgically; however if that does not relieve your pain, surgery may be suggested.

Once your doctor has recommended spine surgery, the next step is deciding which surgical procedure is appropriate for you. Generally speaking, each procedure is defined by the “approach,” or the way in which the surgeon accesses the spine.

Traditional Approaches

Anterior Lumbar Interbody Fusion (ALIF): In this procedure, the spine is approached from the front of the body. This approach spares the back from trauma but requires delicate manipulation of the major blood vessels in front of the spine.

Posterior Lumbar Interbody Fusion (PLIF): This procedure is performed through the middle back, which allows direct access to the area being treated. The downside is that this approach also requires significant disruption to the muscles, bones, and ligaments of the back, which can lead to pain and desensitization after surgery.

Transforaminal Lumbar Interbody Fusion (TLIF): This approach is similar to PLIF, the difference being that only one side of the back is accessed and affected. Like PLIF, significant disruption to the muscles, bones, and ligaments of the back can occur – although limited to one side of the back.

Traditionally, both the PLIF and TLIF approaches require significant muscle, bone, and ligament dissection and/or disruption, which can sometimes lead to pain and desensitization of the back muscles after surgery.

Thoracotomy: This procedure approaches the thoracic spine from the side of the rib cage requiring a large incision and deflation of the lung.

The Advantages of a Lateral Approach

The XLIF procedure does not require entry through sensitive back muscles, bones, or ligaments, resulting in less postoperative pain. It also allows for complete disc removal and implant insertion, compared with approaches from the back. When compared to ALIF, where the surgeon enters from the front, the XLIF procedure offers the benefit of reducing the risk of vascular injury during the procedure.

MAS™ TLIF Comparison

Is XLIF Right for You?

Once your physician has concluded that spine surgery is appropriate for you, the best approach for your condition will then be recommended. The XLIF procedure may be right you if you require surgery at one or more levels above the L5 vertebra.

Some candidates for the XLIF procedure include those:

• Suffering from degenerative disc disease with instability.
• With recurrent disc herniation.
• With instability after a previous non-fusion surgery.
• Who require surgery to a disc adjacent to a previous surgery.
• With a disc that has slipped over another (spondylolisthesis).
• With degenerative scoliosis (curvature of the spine).
• With prior fusion surgeries that did not fuse (posterior pseudarthrosis).

Despite its advantages, your physician may decide that the XLIF procedure is not the most appropriate approach for you. The XLIF procedure is not recommended for the following patients:

• Those suffering from symptoms in the L5 –S1 level of the spine.
• Those with certain lumbar deformities.
• Those with severe degenerative spondylolisthesis (significant slip of one vertebrae over another).
• Those with internal abdominal scarring on both their left and right sides due to abscess or prior surgery.

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