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?

The XLIF^® minimally disruptive procedure can be performed for a number of situations. The list below contains representative examples. The list is not intended to include all possible indications and/or contraindications.

Any thoracolumbar case above L5-S1 requiring access to the disc space and/or vertebral bodies. Examples include:

• DDD with Instability
• Recurrent Disc Herniation
• Degenerative Spondylolisthesis (≤ grade 2)
• Degenerative Scoliosis
• Pseudoarthrosis
• Discitis, Vertebral Osteomyelitis (without active infection)
• TDR Revision
• Post-Laminectomy Instability
• Junctional Disease

Despite its advantages, your physician may decide that the XLIF procedure is not the most appropriate approach for you. Any generally accepted contraindication to fusion include the following:

• Systemic infection
• Osteoporosis
• Significant co-morbidities
• L5-S1
• Lumbar deformities with > 30° rotation
• Degenerative spondylolisthesis > grade 3
• Bilateral retroperitoneal scarring (e.g., abscess or prior surgery)
• Need for direct posterior decompression through same approach
  (Second posterior micro-decompression not contraindicated)
  

It is important that you discuss the potential risks, complications, and benefits of XLIF^® with your doctor prior to receiving treatment, and that you rely on your physician's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.

The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the relationship that you have with your healthcare professional. We do not practice medicine or provide medical services or advice as a part of this Web site. You should always talk to your healthcare professional for diagnosis and treatment. Please use the Physician Locator on www.lateralaccess.org to find a SOLAS^® surgeon in your area.

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