Compared with traditional open approaches, the MIS lateral approach to fusion by using the XLIF technique resulted in a lower incidence of infection, visceral and neurologic injury, and transfusion as well as markedly shorter hospitalization. Complications in MIS XLIF compare favorably with those from other MIS fusion procedures; duration of hospitalization is shorter than with any previously reported technique.

Unlike traditional open lumbar fusion procedures, minimally invasive surgery (XLIF) has no greater risk of complication in the obese patient.

BackgroundLess invasive fusion approaches, such as extreme lateral interbody fusion (XLIF), have proliferated, but few reports have critically assessed fusion rates. To date, no studies have reported computed tomography (CT) documented fusion rates following XLIF.MethodsAn institutional review board-approved prospective radiographic and CT assessment of minimally disruptive anterior lumbar interbody fusion (mini-ALIF) fusions performed through the XLIF approach. Sixty-six patients (88 operative levels) were examined 12 months after XLIF to determine the rate and quality of anterior lumbar fusion.ResultsEighty five of the 88 levels (96.6%) were judged fused by CT. Sixty-four of the 66 patients (97.0%) were judged fused by CT. Patient satisfaction at 12 months after surgery was high, with 89.4% reportedly “satisfied or very satisfied” with their results. No revisions were necessary for pseudarthrosis.ConclusionMini-ALIF using an XLIF approach reliably results in anterior lumbar fusion.

There is considerable published evidence to support MI-LIF in spinal fusion and advanced applications, though the results of some reports, especially concerning complications, vary greatly depending on technique and instrumentation used. Additional cost-effectiveness analyses would assist in fully understanding the long-term implications of MI-LIF.

Surgical treatment need not be withheld on the basis of age; elderly patients can successfully be treated using MIS techniques, and are-in our experience-among the most satisfied with their outcomes, enjoying significant improvements in pain, mobility, and quality of life.