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Change of plan to XLIF - anyone with XLIF experience or knowledge?

SpineAZSpineAZ WiscPosts: 1,084
edited 06/11/2012 - 8:39 AM in Back Surgery and Neck Surgery
I've had two prior PLIF and the original plan was a 360 degree fusion but since there's extensive back scar tissue they've determined an XLIF is a better option (with the possibility of having to do some posterior work if needed). He'll take out my L4-S1 hardware and fuse me L3-L4 or to L5 depending on how that segment looks.

So while I feared the anterior/posterior 360 combo I now see the lateral version can cause quite a bit of pain. Anyone who has had this done recently please let me know your story. I am thinking maybe less time in the hospital than a 2
360 (but I want enough time to get pain under control before they send me on my way).
2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 


  • XLIF was what i was hoping to have -- it's minimally invasive and they sort of push your muscles out of the way instead of having to cut them. You may actually have a much better recovery this way. There are several videos on the web if you google XLIF. You're right - it probably will be less time in the hospital, but they should make sure you're in control of your pain before they send you home. Do you have your surgery date?


    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • SpineAZSpineAZ WiscPosts: 1,084
    I should have the surgery date by this Thursday (hopefully by Friday at the latest). I had been aiming for December for insurance purposes. With the 360 the date would have been in January or February as he'd have to get a thoracic surgeon for the front part. But we've got no plans for the holiday so I'm open to any date. In fact I've stopped taking NSAIDS since you have to be off them for a period before surgery so I'm open to any date if they say they can do it soon.

    I see my pain mgmt doctor this week and will ask him for some neurontin for post-surgery as I understand there can be an increase in nerve pain after XLIF approach. Neurontin has worked for me before but made me a bit tipsy which won't matter if I'm laid up.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Hi, I'm 6 weeks post-op from an XLIF (with pedicle screws and rods) and I couldn't be happier -- or more pain free.

    The first thing I'll say is -- XLIF is as good as the doctor. Check how many of the procedures your doctor has done, how many revisions were necessary, if any, etc.

    I was actually in the hospital 4 nights, and that was estimated upfront. I know all the literature says 1 night and that's just crazy if you're having the screws and rods done. The literature also says it's a hour procedure and mine, which I'm told went so smoothly it "should have been taped for a class," took 3 hours, 1 1/2 for the XLIF, 1 1/2 for the screws. That's a lot of time on anesthesia, so forget the literature. I've never taken painkillers and don't even pop Tylenol so the combination of the painkillers and anti-nausea meds (which worked! Yay!) really knocked me out for two days. I asked them to cut them back -- I didn't need half of what they were giving me -- and progress was immediate re: getting up.

    Seriously, there was minor pain for me, nothing that wasn't controlled easily. Before I left the hospital I'd walked the floor and done 2 flights of stairs (gingerly but still). By the end of the first week I was walking a half mile outside. Within 3 weeks I was down to only half a painkiller before my walks. I am literally pain free when I sit or walk around and I take the painkiller for the distance, as I'm now walking miles a day.

    I know that going through the psoas muscle can cause pain or numbness in a thigh/hip that "is worse than the pre-surgery pain." I had almost no pain but I do have a swath of numbness around my hip and the top of my thigh. Really, I'm unaware of it most of the time. They say this is normal and will resolve anywhere from 6 weeks to 6 months. The thigh was a bit weaker after surgery -- I wasn't racing up the stairs -- but that has resolved.

    Prior to the surgery I had awful pain in the hip -- couldn't walk more than 3 blocks -- and intermittent numbness that started in the thigh but had progressed down the whole leg and was starting on the foot. So to say I'm thrilled and relieved is an understatement.

    Good luck with your surgery!
  • SpineAZSpineAZ WiscPosts: 1,084
    I got the call today that it's scheduled for 2/3. I was hoping sooner but I guess given the holidays it's not that far off.

    I know the new surgeon in his practice is really good at XLIF and they mentioned doing it together. I'll find out more at the pre-op.

    I'm glad to see you had 4 nights. When I did the internet research I was panicking at 1 night but given that he has to take out my L4-S1 hardware first and will either fuse L3-4 or L3-L5 I figured a few nights at least.

    Did they give you a brace and how many levels did you have fused?
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • I asked about a brace but the surgeon's thinking is that he wanted my own core muscles to strengthen, no 'cheating,' so no brace. Surgeons vary widely on that, from what I've read and it may also depend on whether there's hardware. I had L4-5 fused. Hopefully my one and only.

    It's great that you've got a date!

  • Thanks for your post. Good to hear what I can shoot for as a successful outcome. I am 5 days post-op from getting an XLIF procedure and believe I'm doing well. Pain isn't too severe but my left leg is numb/weak. I did have very little strength/ability to lift & move my left leg after surgery but that is coming back a little bit more each day.

    I'll be looking to match your walking regimen in the coming weeks and hope that the healing continues so back pain decreases and that over the coming weeks-months my left leg will return to normal. I want to be doing everything possible to make sure it heals properly.
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