Expandable implants for optimal fusion opportunity. Jun 09, 2011 the spine treatment center, surgical procedures. Suture technique and closure instrumentation the latitude surgical technique has been developed in conjunction with. Case report and discussion of surgical technique extreme lateral interbody fusion xlif. The xlif procedure differs from an anterior interbody fusion alif because the surgeon performs the interbody fusion through an incision in the side of the body as opposed to the front of the body. Pdf anterior and posterior approaches for lumbar interbody fusion can be. Our elearning platform contains high resolution images and a certified cme of the extreme lateral interbody fusion xlif nuvasive surgical procedure. During a plif posterior lumbar interbody fusion procedure, the damaged disc is removed from between two vertebrae in the lower back the lumbar region. The xlif extreme lateral interbody fusion is an approach to spinal fusion in which the surgeon accesses the intervertebral disc space and fuses the lumbar spine low back using a surgical approach from the side lateral rather than from the front anterior or the back posterior. A study by epstein reported that the incidence of lumbar plexus injury during xlif was. Nuvasive, inc, san diego, california is a minimally invasive technique. Abstract the surgical procedures used for arthrodesis in the. It features a true anatomical reconstruction latitude total elbow prosthesis of the joint, modular components, and is adaptable to a wide range of indications. A biomechanical study of regional endplate strength and cage morphology as it relates to structural interbody support.
Surgical treatment of adult degenerative scoliosis ds always remains a challenge and often necessitates complex multilevel surgery via traditional open approaches. The current main techniques of posterior lumbar interbody fusion plif surgery all incorporate a supplementary intervertebral implant. And we conclude that further fact finding is needed as to whether wipo publication no. The xlif technique can be utilized for access to the anterior column of the thoracic and thoracolumbar spine. Lumbar fusion with the xlif technique preoperative information. Complications on minimally invasive oblique lumbar. Clinical outcomes after minimally invasive transforaminal. The nuvasive maximum access surgery mas plif procedure is a minimally disruptive approach to traditional back surgery. Jan 25, 20 the xlif technique can be utilized for access to the anterior column of the thoracic and thoracolumbar spine. Over 400 published clinical studies support the procedure, documenting positive clinical.
Xlif and direct lateral interbody fusion dlif procedures nass, 2010. There are a variety of surgical techniques used to fuse lumbar vertebrae. Be recognized as a regional spine center of excellence that demonstrates innovation in nonsurgical and surgical spine care, and then documents its superior care with clinical outcomes. Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace other than for decompression. Four patients 33% underwent supplemental instrumentation, in 1 patient transpedicular screws were inserted after posterior decompression through an open approach. Extreme lateral lumbar interbody fusion xlif in the management of degenerative scoliosis. Lateral lumbar interbody fusion llif is a relatively new, minimally invasive technique for interbody fusion. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext.
Xlif is the only lateral approach procedure proven by over 10 years of clinical evidence. N united states court of appeals for the federal circuit. Premier pediatric posterior fixation system optimized to treat early onset scoliosis with competitively sized pediatric implants. Wo 07728 kelleher teaches a nervemonitoring technique for the iliohypogastric and ilioinguinal nerves. Extreme lateral interbody fusion xlif is a relatively new technique whereby access to the disc space is achieved through a minimally invasive lateral, retroperitoneal, transpsoas approach. Complications on minimally invasive oblique lumbar interbody. Prior to choosing a particular surgical technique, the goals of surgery must be clearly defined. Shawn odriscoll, md, phd mayo foundation, ken yamaguchi, md washington university, barnes jewish hospital graham king, md, msc university of western ontario 2 table of contents table. Compared to traditional posterior techniques, this approach is also advantageous in revision surgery cases as it allows to reach the vertebral. Endobutton surgical technique pdf the surgical technique of endobutton acufex microsurgical, inc. And llif or dlif or xlif or lateral lumbar interbody fusion or transpsoas lumbar interbody. Severe coronal deformity correction with a modification of. The surgical track is through the retroperitoneal space and then to dilate through the psoas muscle to access the disc space.
Recurrence and reoperation rates can increase, especially in the realm of lumbar disc surgery. The exciting new xlif procedure involves specialized implants and an advanced. You will be positioned on your side on the surgical table and two small incisions will be made. Extreme lateral lumbar interbody fusion xlif in the management of. The lateral transpsoas approach to the lumbar and thoracic spine. An alif approach requires the organs in the abdomen and some of the major blood vessels to be moved to.
The nerves of the lumbar plexus reside within the psoas, and the technique is dependent upon realtime electromyographic monitoring. Event program aospine advanced level specimen course. Direct lateral interbody fusion in patients requiring surgery for spinal instability 2 of this approach. Be recognized as a regional spine center of excellence that demonstrates innovation in non surgical and surgical spine care, and then documents its superior care with clinical outcomes. Threaded cylindrical cages made of titanium, cortical allograft donor bone or synthetic bone. Clinical benefits xlif is the only lateral approach procedure proven by over 10 years of clinical evidence. Pdf extreme lateral interbody fusion xlif researchgate. The advantages of this minimally invasive technique include avoidance of the need for an access surgeon and for lung deflation during surgery as well as excellent visualization of the spinal pathology. In spite of these challenges, the evolution of minimal access spine technique mast has exceeded that of traditional spine procedures over the past 2 decades fig. An introduction to xlif extreme lateral interbody fusion.
Llif includes direct lateral interbody fusion dlif or extreme lateral interbody fusion xlif, which are same regarding transpsoas approach but different based on instruments used. One of the incisions will be made on your side this is the incision from which most of. Extreme lateral lumbar interbody fusion xlif in the. Dlif surgical technique dlif surgical technique 25. The implant used for xlif reaches all the way across the disc space to the opposite side to have a wide footprint in order to decrease surface contact forces. Like the plif posterior lumbar interbody fusion procedure, bone graft is used to fuse the spinal vertebrae after the disc is removed. Surgical treatment of adult degenerative scoliosis ds always. It is designed to treat a range of spinal pathologies. Direct lateral interbody fusion in patients requiring. With a good access surgical team, the complications associated with alif are minimal extreme lateral interbody fusion is a relatively new procedure.
Minimally invasive spine technology and minimally invasive. Surgical technique 4 t us t us acetabular reaming from templating and preoperative planning, determine the desired head position. Every movement that you make will be transmitted to the muscles in your back. For an xlif surgery, we have the patient undergo anesthesia while lying on their back. Lumbar fusion with the xlif technique preoperative. Xlif was created in 2003 and has proven to be a safe and effective technique for spinal fusion that allows for very little discomfort compared to earlier surgical techniques. Learn the extreme lateral interbody fusion xlif nuvasive surgical technique with step by step instructions on orthoracle. The xlif, short for extreme lateral interbody fusion, is an approach to spinal fusion in which the surgeon accesses the intervertebral disc space and fuses the lumbar spine low back using a surgical approach from the side lateral rather than from the front anterior or the back posterior. Start with a smaller reamer, then progress to the next largest size until exposing bleeding cancellous bone. Surgical technique all operations were performed by the same surgeon jun tan. Xlif the industry changing procedure continues to transform patients lives, transform surgical practices, and transform hospitals ability to provide superior, bestincare patient results. The xlif, short for extreme lateral interbody fusion, is an approach to spinal fusion in which the surgeon accesses the intervertebral disc space and fuses the lumbar spine low back using a surgical approach from the side lateral rather than from the. The procedure is performed through the patients side, avoiding the major muscles of the back.
Twentyfive interbody cages were placed with a mean operative time per case of 118 minutes sd 49 minutes, and an average blood loss of 102 ml sd 89 ml when considering only the xlif technique. A transforaminal lumbar interbody fusion tlif is performed to remove a portion of a disc that is the source of back or leg pain. It is not meant to replace any personal conversations that you might wish to have with your physician or other member of your healthcare team. It is a muscle and ligament sparing procedure, allowing, preservation of the spines stabilizer, including the all and posterior osteoligamentous. Impacted cages made of titanium, carbonfiber reinforced or plain peek polymer polyetheretheketone. An introduction to xlif extreme lateral interbody fusion this booklet is designed to inform you about the extreme lateral interbody fusion xlif surgical procedure. The first 30 cases were equipped with emg monitoring, which also verified the safety of the modified entry point.
The search was also limited to english language documents published. To remove the implant, first fit the tips of the removal tool with the divots at the end of the implant figure 42. Xlif and direct lateral interbody fusion dlif procedures. The modern llif technique was described in 2006 by ozgur et al1. Lateral lumbar interbody fusion minimally invasive. Extreme lateral interbody fusion xlif saint camillus. However, the tlif procedure places a single bone graft between.
Direct lateral interbody fusion transpsoas approach dlif surgical technique instrument set 2 preoperative planning 7 nimeclipse spinal system needle electrode placement 8 patient positioning 10 localization 12 dissection to the psoas neuromonitoring through the psoas 14 dilation 16 retractor placement 16 disc preparation 19 trialing 23. Often, patients will note additional painful areas. Each technique has its advantages and disadvantages 1,2. Lateral lumbar interbody fusion xlif is a minimallyinvasive procedure used to treat leg or back pain generally caused by degenerative disc disease. Surgical outcome and related complications in an academic center. Jul 01, 2010 extreme lateral interbody fusion xlif. Surgical procedures extracavitory lateral interbody. Case report single transverseorientation cage via mis. The extreme lateral interbody fusion xlif technique is a minimally disruptive surgical procedure performed through the side of the body. Many different surgical approaches for the treatment of pain caused by severe coronal deformity have been developed and can range from the simple limited decompression to multilevel fusion procedures 3,6. Novel implementation of extreme lateral interbody fusion. Accordingly, we vacate the boards obviousness and re determination.
Take extra care to avoid eccentric reaming by holding the reamer steady. The xlif extreme lateral interbody fusion procedure provides relief to patients who cannot tolerate a larger, open back surgery because of the increased. Surgical procedures extracavitory lateral interbody fusion. Jan 19, 2019 endobutton surgical technique pdf the surgical technique of endobutton acufex microsurgical, inc. Therefore, during the last decade, minimally invasive procedures have. Surgical treatment of adult degenerative scoliosis ds always remains a challenge and. We continue to train surgeons on the xlif technique and our other mas platform products including.
No significant variation in these lateral approach techniques or surgical indication has been reported. Extreme lateral lumbar interbody fusion xlif journal of spine. Xlif for the treatment of lumbar pathology it was first published in the literature in 2006, and description of the technique, as well as its anatomical details, have been widely described 1215. Over 400 published clinical studies support the procedure, documenting positive clinical outcomes such as reduced blood loss, less time in the o. The surgical technique to proper pull the polyetheretherketone cage back into the. Lumbar transforaminal lumbar interbody fusion tlif. Xlif, extreme lateral interbody fusion, and tlif or transforaminal lumbar interbody fusion both minimally invasive procedures.
The xlif procedure turning spine surgery on its side when performing xlif back surgery, your surgeon will approach your spine from the side of your body. Olif is an emerging procedure that has progressively been used by spine surgeons 3,4. Direct lateral interbody fusion in patients requiring surgery for. Materials and methods indications and surgical candidates transpsoas lateral interbody fusion has the same surgical indication as posterior lumbar decompression or. Jun 16, 2015 xlif extreme lateral interbody fusion is a gentle, less invasive spinal fusion alternative for patients whose spinal condition requires a fusion to be fixed. A lateral approach is made safe with the use of nerve monitoring. Summary of the technique steps insertion and rotation for placement of transverseorientation cage.
Previously, patients who required spinal fusion were faced with complex vascular surgery, large incisions, and a lengthy recovery. Xlif complication in a consequtive series of patients. In an xlif procedure, the spine is approached from the side of the body. Nov 09, 2018 extreme lateral interbody fusion xlif surgical technique.
Should it be necessary to remove or reposition the clydesdale spinal system device, the removal tool may be used. A novel, fully porous titanium implant created through an additive, 3dprinted manufacturing process. Oneill will use as minimally invasive of a procedure as possible, back surgery can be painful. As surgeons become more proficient in the operation and as surgical technique is refined, sensory dysesthesias and psoas trauma associated with the procedure are becoming less prevalent.
Xlif extreme lateral interbody fusion is a gentle, less invasive spinal fusion alternative for patients whose spinal condition requires a fusion to be fixed. Mansfield, ma button fixation for anterior cruciate ligament reconstruction is. Anysurgical techniqueinstructionmanualshouldbecarefullyfollowed. The occasion of the first operative demonstration of dlif technique in thailand on. Mas plif maximum access surgery spine surgeons, physical.
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