Lateral lumbar interbody fusion is a minimally invasive spinal fusion performed through the side of the body, avoiding the back muscles and major blood vessels. A large cage is placed in the disc space to restore disc height and promote fusion.
An incision is made on the side of the abdomen. Using specialised dilators, a corridor is created through the psoas muscle to reach the spine. The disc is removed and a large cage filled with bone graft is inserted. The procedure may be supplemented with posterior screws placed percutaneously. The operation takes one and a half to two hours per level.
XLIF/LLIF is recommended for degenerative disc disease, spondylolisthesis, degenerative scoliosis, and adjacent segment disease. The lateral approach allows a large cage to be placed, providing excellent support and indirect decompression of the nerves.
Physiotherapy, pain management, epidural injections, and activity modification. Posterior or anterior fusion approaches are surgical alternatives.
CT and MRI for planning. Vascular imaging may be needed to assess vessel position. Standard pre-assessment.
Effective fusion with indirect nerve decompression, less back muscle damage than posterior approaches, and shorter hospital stay. Fusion rates exceed 90%.
Psoas muscle irritation causing temporary hip flexion weakness. Very common (up to 30%) and usually resolves within weeks.
Lateral femoral cutaneous nerve irritation. Usually temporary.
Temporary slowing of bowel function due to abdominal approach.
Nerve damage causing leg weakness. Risk approximately 1-3%.
Damage to segmental vessels. Rare but potentially serious.
The cage may sink into the vertebral body, particularly in osteoporotic bone.
Failure to fuse despite cage placement.
Wound or deep infection.
General anaesthesia. Positioned on the side (lateral decubitus). Neuromonitoring is used.
Hospital stay one to three days. Walking on the day of surgery. Hip flexor exercises begin immediately. Return to desk work at two to four weeks. Avoid heavy lifting for three months. Full fusion at six to twelve months.
X-rays at six weeks, three months, and six months. CT scan to confirm fusion if needed.
The lateral approach avoids the back muscles (reducing post-operative pain) and the major blood vessels in front of the spine, while allowing placement of a larger cage than posterior techniques.
Yes, in the vast majority of cases. The psoas muscle recovers within two to six weeks.