Extreme lateral lumbar interbody fusion (XLIF) in the management of degenerative scoliosis: a retrospective case series

Abstract

Background: Surgical treatment of adult degenerative scoliosis (DS) always remains a challenge and often necessitates complex multilevel surgery via traditional open approaches. However, the severity of the procedure, in association with the fact that many of these patients are at an advanced age with several comorbidities, results in high rate of complications. Therefore, during the last decade, minimally invasive procedures have gained a place in the treatment of this pathology. Our aim is to determine the safety and efficacy of extra lateral lumbar interbody fusion (XLIF) with or without supplemented instrumentation in the treatment of DS.Methods: In a retrospective case series study, we reviewed the files of patients who underwent XLIF in our Hospital between 2008 and 2017. We recorded the patients' demographic characteristics, clinical parameters such as back-pain [visual analogue scale (VAS)] and back-related disability [Oswestry Disability Index (ODI)], as well as radiological parameters including the Cobb angle. Comparison of the before and after results were performed with the t-test and Chi-square test, where appropriate.Results: Twelve patients fulfilled the eligibility criteria of our study. All patients were female, with a mean age of 64.5 years (SD =7.8 years) and 28 months (SD =13 months) follow-up. The XLIF decreased the pain intensity by 4.66 cm (SD =1.23 cm), and improved the back-related disability by 26% (SD =8.35%) in the ODI scale at the 6-month follow-up. Similarly, scoliosis improved by an average of 11.5° (SD =7°) and lordosis changed by an average of 13.5° (SD =10.86°). All changes were statistically significant. There were three complications, two patients presented meralgia paresthetica, which resolved spontaneously in 3 months, and in one patient occurred an intraoperative bowel perforation treated with bowel anastomosis.Conclusions: XLIF is a feasible and efficient alternative in the treatment of DS. It can be the treatment of choice in elderly patients in whom comorbidities increase the perioperative risk of complications.

Extreme lateral interbody fusion (XLIF) in a consecutive series of 72 patients

“…In lumbar interbody fusion, MIS-TLIF (minimally invasive transforaminal interbody fusion) had better ODI, VAS pain, and complication rate when compared to XLIF with direct and indirect meta-analysis methods;however, in terms of fusion rates, there were no differences between the two techniques[ 44 ].Radiological outcome showed similar results in patients with degenerative spinal canal stenosis and spondylodiscitis. Improvement of regional lordosis (increase of sagittal L1-S1 angle of 36.2⁰ preoperative vs. 38.09⁰ postoperative) showed consistence with previous studies[ 7,25,29,30 ]. However, measurement of the regional and segmental coronal Cobb angles did not show correction but rather a slight angle increase (4.28⁰ preoperative vs.…”

“…Extreme lateral interbody fusion (XLIF) has become the standard of minimally invasive therapy of the degenerative lumbar spine disease and spondylodiscitis due to minimally invasive access to the spine, less blood loss compared to open procedures, decreased operative times, earlier mobilization, shorter hospital stays, and less postoperative pain [1][2][3][4][5][6][7][8].…”

Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation

“…Currently, mostly biomechanical studies evaluating lateral interbody fusion were usually focused on one or two levels [ 4 , 7 , 8 ]. However, for patients with degenerative spinal scoliosis or multilevel lumbar disease, three or even more levels LLIF are necessary to effectively correct spinal deformity and completely decompress neural elements [ 9 , 10 ]. Although, laterally placed cage was associated with superior segmental stability compared with ALIF and TLIF cages, cage subsidence and interbody un-union were usually observed in stand-alone LLIF compared to those with supplemental fixation, especially in multilevel condition [ 11 – 15 ].…”

Review of Risks and Complications of Extreme Lateral Interbody Fusion (XLIF)

“…(study years 2008-2017) retrospectively studied the efficacy of XLIF for treating degenerative scoliosis involving 12 patients averaging 64.5 years of age, and followed for 28 months [Table 2]. [21] Although they found the back-related Oswestry Disability Scales (ODS) improved by 26% at 6 postoperative months, there were three major complications; 2 instances of meralgia paresthetica, and one intraoperative bowel perforation (requiring resection/anastomosis).…”