An Overview of Far Lateral Lumbar Spine Fusions: Direct Lateral Interbody Fusion (DLIF) & Extreme Lateral Interbody Fusion (XLIF)
The extreme lateral interbody fusion (XLIF) or direct lateral interbody fusion (DLIF) are procedures designed to have access to the front of the upper and mid levels of the lumbar spine (L1-5), similar to an ALIF without the dangers of an approach through the belly. The L5-S1 level cannot be approached using this technique.
The approach is performed through the side of the belly wall behind the intestinal sack and through the psoas muscle. The psoas is the muscle that flexes the hip joint and that lifts the upper leg when ascending stairs.
This muscle resides right next to the vertebral body in the front of the spine. Between the psoas muscle and the vertebral body lies the femoral and sciatic plexuses, the nerves that travel down to make the legs work. An approach through this area does put these nerves at risk for injury due to compression or stretch.
Large girth and obese patients have more potential complications due to the additional depth that has to be accounted for.
A PEEK cage is generally implanted into the disc space. This cage may contain the patient’s own bone, donor bone, a bone substitute or BMP (bone morphogenic protein)
Generally, a far lateral lumber spine fusion procedure is “backed up” by posterior instrumentation of pedicle screws and rods implanted through a separate incision in the back of the spine.
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