This article describes a case of a complication unique to this procedure and the surgical technique used to treat it. The extreme lateral interbody fusion xlif technique is a minimally disruptive surgical procedure performed through the side of the body. This technique combines the advantages of alif and xlif, while compensating for their respective shortcomings potential risks of vascular injury in alif and nerve injury in xlif. Efficacy of oblique lateral interbody fusion in treatment. Xlif for the treatment of lumbar pathology it was first published in the literature in 2006, and description of the technique, as well as its anatomical details, have been widely described 1215. Incidence of major vascular injuries with extreme lateral. A lateral approach is made safe with the use of nerve.
However, the reported complications associated with this approach vary. The procedure, called xlif extreme lateral interbody fusion, involves a lateral, or side, approach to spine surgery, rather than from the back or front. It features a true anatomical reconstruction latitude total elbow prosthesis of the joint, modular components, and is adaptable to a wide range of indications. The mis lif procedure has been described previously.
Risk of sympathectomy after anterior and lateral lumbar interbody fusion procedures. Xlif surgical technique study guide flashcards quizlet. Shortterm outcomes of lateral lumbar interbody fusion. Thank you i have got that part of the coding but what i am not sure about is do i code for the.
Lateral lumbar interbody fusion minimally invasive. A lateral side approach is made safe with the use of nerve monitoring technology nvjjbm5 from nuvasive, inc. The patient is positioned on a jackson flat table in the right lateral decubitus position allowing a leftsided approach. The nerves of the lumbar plexus reside within the psoas, and the technique. However, the tlif procedure places a single bone graft between. There is a wide variety of instrumentation and technique options. Like the plif posterior lumbar interbody fusion procedure, bone graft is used to fuse the spinal vertebrae after the disc is removed. The better way back spinetrack registry reach your height find a surgeon surgeons nuvasive is committed to. Complications of the lateral transpsoas approach for. Threaded cylindrical cages made of titanium, cortical allograft donor bone or synthetic bone.
For an xlif surgery, we have the patient undergo anesthesia while lying on their back. Shortterm outcomes of lateral lumbar interbody fusion without decompression for the treatment of symptomatic degenerative spondylolisthesis at l45 peter g. We continue to train surgeons on the xlif technique and our other mas platform products including. Extremelateral lumbar interbody fusion xlif somato. The following general surgical technique guide is for illustrative purposes only. The access driver allows 2 different points of attachment. Extreme lateral interbody fusion xlif has been widely used for minimally invasive anterior lumbar interbody fusion alif, but an approach to l5s1 is difficult because of the iliac crest.
Fluoroscopic xray images also are used to guide the probe to the proper position on the. Twentyfive interbody cages were placed with a mean operative time per case of 118 minutes sd 49 minutes, and an average blood loss of 102 ml sd 89 ml when considering only the xlif technique. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. The integration of these procedures into a single system allows for significant time savings through the use of modern, less invasive techniques performed with the patient in lateral throughout the entire surgery. Coding xlif l34 and l45 with facet fusion l34 and l4. In 2017, we announced the expansion of our surgeon education program into a clinical professional development global platform, which integrates surgical. Major vascular complications in smalllarger case series of xlifmi xlif. Larger cage height than tlif but not quite xlif or alif pack graft into entire disc space multiple levels, single incision with time equivalent or faster than xlif possible l5s1 option approx. Extreme lateral lumbar interbody fusion xlif in the. The lateral transpsoas approach to the lumbar spine was developed to eliminate the need for an anteriorapproach surgeon and retraction of the great vessels and has the potential for shorter operative times. During a plif posterior lumbar interbody fusion procedure, the damaged disc is removed from between two vertebrae in. Xlif the industry changing procedure continues to transform patients lives, transform surgical practices, and transform hospitals ability to provide superior, bestincare patient results. The discussion of xlif includes indications, surgical technique, postoperative care, possible complications, and outcomes. As with all surgical procedures, the technique used in each case will depend on the surgeons medical judgment as to the best treatment for each patient.
The procedure, called xlif extreme lateral interbody fusion, involves a lateral, or side, approach to spine. The nerves of the lumbar plexus reside within the psoas, and the technique is dependent upon realtime electromyographic monitoring. Extreme lateral interbody fusion xlif in the thoracic. Orthopedics abstract extreme lateral interbody fusion xlif.
The technique has been previously described, 18,19 and is performed with the patient in the lateral decubitus position and, following skin and fascial incision, blunt dissection is used to pass. The patients showed foraminal stenosis between l5 and s1 and severe low back and leg pain. Clinical benefits xlif is the only lateral approach procedure proven by over 10 years of clinical evidence. Pay attention to your physicians documentation and the additional levels you code, because the surgeon usually can access only one or two levels at a time. Nuvasive, inc, san diego, california is a minimally invasive technique developed to avoid complications associated with traditional. Furthermore, we report a case who suffered from an inadvertent intraoperative bowel perforation, a rare complication described for this technique. We identified the incidence of complications associated with the lateral transpsoas approach to the lumbar spine. A transforaminal lumbar interbody fusion tlif is performed to remove a portion of a disc that is the source of back or leg pain. Xlif procedure minimally disruptive procedure for spine surgery. Expandable tlif and plif technology surgical technique.
In the current study, we present 2 cases using minimally invasive oblique lateral interbody fusion olif of l5s1. This technique is utilized when the stenosis is caused by or associated with scoliosis, instability spondylolisthesis or severe disc degeneration. Assessment and classification of subsidence after lateral. Only those individuals with specialized training and experience in spinal surgery should attempt to use the. Lateral lumbar interbody fusion xlif surgery recovery time. Lumbar transforaminal lumbar interbody fusion tlif. Minimally invasive lateral lumbar fusion xlif this is also a minimally invasive procedure for lumbar spinal stenosis.
The procedure is performed through the patients side, avoiding the major muscles of the back. Extreme lateral interbody fusion xlif is a relatively new technique whereby access to the disc space is achieved through a minimally invasive lateral, retroperitoneal, transpsoas approach. Larger cage height than tlif but not quite xlif or alif pack graft into entire disc space multiple levels, single incision with time equivalent or faster than. The advantages of this minimally invasive technique include avoidance of the need for an access surgeon and for lung deflation during surgery.
Preoperative planning and patient positioning are important to maximize the efficiency of the procedure. Our elearning platform contains high resolution images and a certified cme of the extreme lateral interbody fusion xlif nuvasive surgical procedure. Lateral lumbar surgery is typically used to treat leg or back pain caused by degenerative disc disease. Resources nuvasive is dedicated to providing continued support and resources to patients and surgeons from preop to postop. There are a series of steps performed to complete an xlif spinal fusion. The second incision is used to help guide the surgical instruments. Nonneurological major complications of extreme lateral. Suprapsoas shallow docking in lateral interbody fusion. Four patients 33% underwent supplemental instrumentation, in 1 patient transpedicular screws were inserted after posterior decompression through an open approach, and in 3 patients the.
Twoyear comparative outcomes of mis lateral and mis. One of the incisions will be made on your side this is the incision from which most of. Impacted cages made of titanium, carbonfiber reinforced or plain peek polymer polyetheretheketone. The objective of this study was to describe our initial experience with an adaptation of the extreme lateral interbody fusion xlif technique allowing access to the anterior aspect of the thoracic and thoracolumbar spine with specific reference to 1 early pulmonary complications, 2 nonpulmonary complications, and 3 ability of this technique to successfully achieve spinal. The side selection and positioning are critical and need to be addressed during the preoperative planning of the. The current main techniques of posterior lumbar interbody fusion plif surgery all incorporate a supplementary intervertebral implant. The surgeon uses the probe to stimulate and detect nerves along the side of the spine. Surgical procedures extracavitory lateral interbody. It is a muscle and ligament sparing procedure, allowing, preservation of the spines stabilizer, including the all and posterior osteoligamentous. It is designed to treat a range of spinal pathologies. Lumbar fusion with the xlif technique preoperative. This technical note describes our surgical technique using suprapsoas retractor docking and discusses the benefits that this technique may provide for both the surgeon and the patient.
Timberline lateral fusion system surgical technique guide. First, the patient will be positioned lying on his or her side. Spine extreme lateral interbody fusion xlif neurodiagnostics. Each physician should exercise his or her own independent judgment in the diagnosis and treatment of an.
After induction of general anesthesia, neuromonitoring leads are placed so that somatosensory evoked potentials and electromyography are monitored. Over 400 published clinical studies support the procedure, documenting positive clinical. The incidence of major vascular injuries occurring for transpsoas xlifmi xlif performed in the 5 small and larger case series involving a total of 6,732 patients range from 12 to 4,607 patientseries ranged from 0% 3 studies to 0. Learn the extreme lateral interbody fusion xlif nuvasive surgical technique with step by step instructions on orthoracle. The cages were 50, 55, or 60 mm in length lateral dimension, 18 or 22 mm in width anterior to posterior, and 8, 10, or 12 mm in height. Lateral lumbar interbody fusion xlif is a minimallyinvasive procedure used to treat leg or back pain generally caused by degenerative disc disease. Pdf on mar 10, 2016, ioannis siasios md and others published extreme lateral interbody fusion xlif. When a nerve is found it can be avoided and left undamaged. The quantitative analysis of tissue injury markers after miniopen lumbar fusion.
Then the surgeon will use xrays to locate the disc that will be removed once the disc is located, the surgeon will mark the skin with a marker directly above the disc. For an xlif surgery, we have the patient undergo anesthesia while lying. Nunley md 2, david cavanaugh md 1, eubulus kerr md 2, philip andrew utter. Patients the better way back provides hope, support, and information to patients suffering from chronic back, leg, and neck pain. Benefits xlif surgery traditional lumbar interbody fusion surgery blood loss xlif is a relatively new technique whereby access to the disc space is achieved through a minimally invasive lateral, retroperitoneal, transpsoas approach. You will be positioned on your side on the surgical table and two small incisions will be made. Xlif was created in 2003 and has proven to be a safe and effective technique for spinal fusion that allows for very little discomfort compared to earlier surgical techniques. Xlif extreme lateral interbody fusion is a gentle, less invasive spinal fusion alternative for patients whose spinal condition requires a fusion to be fixed. The xlif technique can be utilized for access to the anterior column of the thoracic and thoracolumbar spine. The xlif procedure turning spine surgery on its side when performing xlif back surgery, your surgeon will approach your spine from the side of your body. Particular attention is given to indications, surgical technique, advan tages, and potential complications of this approach in the surgical treatment of spinal.
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