Preparation for spine surgery begins with a patient history, a physical exam, and imaging to confirm the spinal disease, to determine the affected level, and to decide on the type of surgery. XLIF is a minimally invasive stabilization procedure used to treat spine disease symptoms in the lumbar region. Because this procedure is performed between the hip and the ribs, its use is limited to diseases affecting specific lumbar vertebrae unlike a procedure such as Transverse Lumbar Interbody Fusion (TLIF).

The XLIF is performed with the patient lying on their right side with the left side pointed upward. The knees are bent to relax muscles in the spine and special care is taken to position the body to target the affected vertebra. An intraoperative x-ray machine is used throughout the procedure to ensure that the correct vertebra/vertebrae is being operated on. After locating the proper vertebra, the skin is marked, cleaned, and draped for sterility. A small incision, less than one inch, is made on the left side of the body and specialized neuromonitoring is used to gently part the psoas muscle in the side until the spine is reached.

Once the spine is exposed specialized retractors keep the incision open for the duration of the procedure, allowing the surgeon to see and operate without surgically opening the back. No bone is removed because the vertebrae are approached from the side, but ligament tissue is removed to create access to the affected intervertebral disc, which is then removed with a series of biting instruments. The empty disc space is measured to select an implant that will fit in the space and intraoperative imaging is used to confirm implant fit and spinal alignment. Once the correct size implant has been chosen, it is filled with bone graft either from the patient or a cadaver, and placed into the empty disc space to create a fusion; the implant is secured into the bone, typically with screws, in order to prevent further motion at the spinal level. Then the retractors are removed from the incision, bleeding is controlled, and a final neuromonitoring check is performed. Each layer of tissue is closed with sutures and the final layer of skin is usually closed with a special medical grade glue, which typically leaves less scaring after healing; the final layer may be fully closed with sutures depending on the surgeon’s preference and on the patient’s skin.

After surgery the patient recovers in a post-operative room to make sure that their pain is under control, that they are able to eat and tolerate food and beverage, and that they can walk and urinate properly. They are able to go home within 23 hours of the procedure, but a friend or family member should be available to drive the patient home and to monitor the patient for at least 24 hours after the procedure.