eXTREME LATERAL INTERBODY FUSION (XLIF)

Extreme Lateral Interbody Fusion is a minimally invasive surgical procedure where the spine is accessed through side of the the abdomen (i.e. "flank"). It is used for lumbar fusion from L1 to L5, but cannot be performed at L5-S1. The procedure begins with two small incisions on the side of the abdomen one directly over the center of the disc and the other slightly towards the back. The abdominal contents are enclosed in a large sack (peritoneum) which is pushed forward, allowing access to the spine. A dilator is then introduced through the side incision and rests on top of the psoas muscle (long muscle on the side of the lumbar spine) directly over the center of the disc. The dilator is then advanced through the muscle while monitoring the proximity of nerves using a special nerve monitoring system called NeuroVision®. Different sized dilators are subsequently introduced over the initial dilator, again monitoring each time nerve proximity. Once the last dilator is positioned, a specialized retractor is placed on the spine and the dilators are removed. At this point the disc can be visualized, removed, and a PEEK cage (polyetheretherketone) is inserted into the disc space. Finally, either a plate is placed on the side of the spine over the cage and

You will be advised, if possible, to donate at least 2 units of your own blood approximately 1 month prior to your surgery date. We will provide you with the information to schedule this appointment with the American Red Cross. Usually, only one unit is donated at a time, so it may take you two to three visits to the blood bank to acquire the necessary amount of blood. In some cases, family members with the same blood type may donate instead, which is called directed donor blood. If for some reason you or your family cannot donate blood, screened donor blood from the blood bank may be used. Prior to your surgery date, you will be required to undergo routine laboratory tests, EKG and a chest x-ray. If you are over 50 years of age or have any history of cardiac or pulmonary problems, you will also be required to have a clearance by a cardiologist or pulmonologist, respectively. You will also be given information on what medications, both prescription and over the counter, that need to be discontinued preoperatively

What to expect in the hospital postoperatively
You will wake up in the recovery room after the operation is over. During this time you may be disoriented and tired, which is the normal effects of the anesthesia wearing off. Once stable, you will be taken to your room where you may be greeted by friends and family. At this time your pain will be controlled by IV medications and you will have a catheter placed into your bladder to drain urine. Your incision will be covered by a sterile dressing which will stay in place for 2 to 3 days.

It is important to begin moving as soon as possible to prevent blood clots and speed your recovery. Typically, the evening after surgery you will be able to get out of bed and walk around with the assistance of a physical therapist. It is important to use your brace while out of bed.

Getting out of bed is also a very important step in helping your lung function return to normal. Areas of your lungs collapse during surgery and a couple of days post-operatively, which is known as "atelectasis". Additionally, deep inspirations and the use of your "incentive spirometer" are essential. Patients typically stay in the hospital overnight, however, this can vary between patients. Before your discharge, you will be provided with a list of "do’s and dont’s" and arrangements will be made for home health if necessary.

Once you arrive home
Continue to walk with the use of aids (i.e. front wheel walker) and your brace. Slowly increase your activity level. Outpatient physical therapy will begin between 4 to 6 weeks after surgery.
You may shower, but do not soak in the bath or hot tub for 4 to 6 weeks.
Once the dressing is removed and you are informed to keep it open to the air, make sure that you protect it from sun exposure. Once the incision is healed, sunscreen should be on the incision for 6 months to one year. This will help decrease its appearance.
Maintain a healthy diet, especially one that is high in dietary fiber to decrease constipation. Additionally, a diet rich in protein is ideal for the healing process. Drink plenty of fluids.
Monitor your incision. It is common to have a small amount of blood and fluid leakage, however, if there is persistent drainage contact the office. Additionally, watch for opening of the incision, redness or warmth around the incision, or fever greater than 101ºF.
No driving for 4 to 6 weeks or until advised.
No lifting greater than 5 pounds for 4 to 6 weeks. No bending at the waist or twisting the back.
No jumping, running, or high-impact sports. After 2 months, appropriate exercise include: stair climber, elliptical, stationary bike, and of course walking.
No golfing for a minimum of 3 to 4 months.
Do not take anti-inflammatory medications (i.e. Ibuprofen, Voltaren, Aleve, Feldene, Lodine, Daypro, Naproxen, Naprosyn, Relafen, and Motrin) for 3 months after the surgery as this may inhibit bone fusion.
Smoking also interferes with bone fusion; therefore patients who smoke should make every attempt to stop smoking before surgery. If you need additional assistance, contact 1-800-NO-BUTTS for free information.

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