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Anyone here have XLIF?

watchyurbackwwatchyurback Posts: 73
edited 06/11/2012 - 8:47 AM in Back Surgery and Neck Surgery
I'm facing a possible date with the surgeon next month for a so-called XLIF procedure, or extreme lateral interbody fusion. I've read some posts here that give it mixed reviews, with the biggest concern apparently being post-operative nerve damage and muscle pain.
On the other hand, it seems like a less invasive surgery than traditional open back surgery or PLIF, so there's some distinct advantages for me. It would be my third spine surgery. The first two were a 360-degree instrumented fusion from L4-S1 plus laminectomy and foraminotomy.
Almost two years after that major two-stage operation, I'm in worse pain than ever. The problem is clearly at the adjacent level (L3-L4), where the disc is severely protruded and the facet joints are pretty shot.
I'd love to hear from anyone who has had the XLIF procedure. This surgery would not include any instrumentation other than the cage that replaces the worn-out disc.
I'd be up for doing this procedure if there's a decent chance it will relieve my pain at L3-L4. However, I know that fusing this level will likely just lead to a breakdown at L2-L3, and I'll be back for more surgery in two years.
My surgeon is quite realistic about my prospects. He says there's a 60 percent to 70 percent chance I'll get significant pain relief from the procedure. That's a lot more honest than the 80 percent to 90 percent positive outcome that some surgeons claim for their fusion patients.
Thanks in advance,



  • I know j.howie had xlif hopefully he will see your post or you can send him a private message or add buddy so he'll get an e-mail. Best wishes for your upcoming surgery. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,730
    Hi -PM, Our stories are similar. And I had a XLIF at L-2, L-3 1/19/10 My surgeon was also very realistic as to the possible outcome. Due to so much nerve damage from the previous surgeries, He said he was hopeful to bring the pain level down from a 6 with meds to a 3,4, with half the meds. Everything went pretty well until at 6 mo. I was at my grandsons motocross race. And a kid crashed in a bad turn and other riders were running over him. There was no one there but me to help. I did and haven't been the same since. A surgery is a surgery and there will be pain and all of the other problems post surgery. BUT, not as much. It was much less invasive with less hospital stay. And quicker recovery. But if you see the film clips of a kick boxer getting back in the ring in 3 or 4 mo. or a older guy like me back on the golf course in 6 or 7 mo. That didn't happen for me and probably won't happen for you. But, given the choice between the PLIF or the XLIF. It's a no brain er. The only problem I've heard of. Is the possibility of the Psoas muscle giving you problems. But at the level your going for. There is less chance. My big complaint was I'm tired of having surgeries due to the next level going out. I had a tall basket with BMP. Why they can't invent a replacement disc with super suspension, so the adjacent disc wont go out is beyond me. It shouldn't be rocket science! I don't come to the forums very much right now. I'm caring for my mother who has terminal cancer. Trading off 24-7 care for her with my siblings. But I would be more than happy to try to answer any questions you may have. Just P.M. me.
    Good luck, Jim
    Click my name to see my Medical history
    You get what you get, not what you deserve......I stole that from Susan (rip)
    Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!
  • We live in a world of extremes, and I hate how marketing buzzwords have invaded the world of medicine and now we have "extreme" lateral interbody fusion. But that's another subject for another post.
    Thanks Jim for your interesting story about your post-XLIF experience (and near-death experience, it seems, on the motorcycle track; God bless you for your actions!).
    Funny you mention artificial disc replacements and why they haven't come up with one that's just like the real thing. My surgeon and the entire spine clinic where he works have stopped doing artificial discs because there were too many device failures and other problems. They were doing all of the approved devices, and none were satisfactory.
    I have read of an artificial disc replacement that's made by a privately held company in Silicon Valley. They have a cervical ADR that's been approved in the U.S. for investigational use only, and a lumbar one that's available in Germany. It claims to be just like the real thing, with an artificial nucleus and annulus etc.
    I have my doubts, but I really hope that sometime soon someone will come up with a reliable alternative to fusion, which, as you and I both know, tends to move the problem up a notch as it eliminates motion in the affected segments.
    Your description of the XLIF procedure itself gives me some hope, i.e. it appears to be much less invasive than fusion. I guess the question remains how well it performs in the long term.
    Feel free to send me another PM if you would like more info on the investigational device I mentioned.
    Best regards,
  • Hi,

    I remember reading on XLIF and when I was facing possible fusion, I read about it a lot. No one near me did them and at the time my insurance didn't cover it. However, I did investigate Minimally Invasive TLIF which TLIF. I guess TLIF/PLIF are sometimes interchangeable. Anyhow, MI TLIF are smaller incision and the MI part is that they do not disrupt the muscle tissue as much.

    As for nerve damage concerns, on my revision microdiscectomy, they used Nerve monitoring. I believe they use it automatically with XLIF surgeries but it is something you'll want to ask about. I had a neuro team specially monitoring my nerves on my 2nd MicroDiscectomy because I had so much scar tissue. The monitor is like EKG & Accupuncture from what it looked like (I talked to them b/c they prepped me while I was still awake). I swear that it's the reason my 2nd surgery was a much easier recovery.
    Good luck.
  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,730
    If you type that into the blue search box at the top of the page, click, and begin to surf. You can get all of the info that you could possibly want on XLIF and nuvasive nerve monitoring......Interesting.
    I'm off to due my mommy-sitting and see the P.M. Dr. and the surgeon on Mon. Hoping to find out how to correct this damage. The pain is right back up there where it was before the surgery!
    Good luck, Jim
    Click my name to see my Medical history
    You get what you get, not what you deserve......I stole that from Susan (rip)
    Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!
  • I am really curious about the benefits of a 4 level spinal fusion from my L2 to the S1 and what I can hope to achieve. I am advised to have it sooner rather than later to prevent severe nerve damage prior to the surgery.
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