Introduction: Extreme Lateral Interbody Fusion(XLIF) is a relatively new technique whereby access to the intervetebral disc space is achieved through a minimally disruptive, retroperitoneal, trans-psoas approach to the spine. Theoretically, XLIF avoids all posterior approach-related complications, mitigating the risk for associated neurologic and dural related complications. While numerous studies have demonstrated excellent results following both XLIF and posterior approaches, controversy still exist regarding the best operative procedure. The primary aim of the study was to compare post-operative complication rates and hospital re-admission rates following both approaches.
Methods: A retrospective analysis of prospectively collected data on one hundred and fifty-seven patients undergoing long-segment fusions between 2007 and 2011. All patients underwent surgery on at least four spinal levels. XLIF surgical procedure was performed on 45 patients with 112 patients undergoing traditional posterior approaches for degenerative disc disease, infection, deformity and instability. Early complications were defined as an adverse event occurring within the month of index procedure. Documented complication types and rates were compared between both cohorts.
Results: Both patient cohorts were similar at baseline, Table 1. Overall estimated blood loss and operative time were 1143 ± 540 mL(XLIF: 508 ± 652mL, PLIF/TLIF: 1249 ± 651mL) and 353 ± 138 minutes (XLIF: 408 ± 160 minutes, PLIF/TLIF: 336 ± 160 minutes) respectively. Overall, length of hospital stay was 6.31±5.04 days. 37% of patients experienced atleast one post-operative complication, however, patients undergoing long segment fusions via a posterior approach were more likely to experience a post-operative complication (42% vs. 24%, p=0.03). 30-day re-admission rates were similar between both cohorts(p=0.84).
Conclusions: Our study suggests that extreme lateral interbody fusion compared to traditional posterior approaches is associated with significantly lower 30-day post-operative complication rates, shorter length of in-hospital stay and similar long-term reoperation rates, and should be considered a viable alternative for patients requiring long segment fusions.
Patient Care: Our research shows evidence of efficacy for a alterative therapy for long segment fusions.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the indications for using XLIF and 2) the complications of XLIF versus posterior approaches