European Spine Journal

, Volume 24, Supplement 3, pp 369–371 | Cite as

Fusion rate following extreme lateral lumbar interbody fusion

  • Pedro Berjano
  • Francesco Langella
  • Marco Damilano
  • Matteo Pejrona
  • Josip Buric
  • Maryem IsmaelEmail author
  • Jorge Hugo Villafañe
  • Claudio Lamartina
Original Article



Lumbar fusion has been found to be a clinically effective procedure in adult patients. The lateral transpsoas approach allows for direct visualization of the intervertebral space, significant support of the vertebral anterior column, while avoiding the complications associated with the posterior procedures. The aim of this study is to determine the fusion rate of inter body fusion using computed tomography in patients treated by extreme lateral intersomatic fusion (XLIF) technique.

Materials and methods

All patients intervened by XLIF procedure between 2009 and 2013 by a single operating team at a single institution were recruited for this study. A clinical evaluation and a CT scan of the involved spinal segments were then performed with at least 1-year follow-up following the standard clinical practice in the center.


A total of 77 patients met inclusion criteria, of which 53 were available for review with a mean follow-up of 34.5 (12–62) months. A total of 68 (87.1 %) of the 78 operated levels were considered as completely fused, 8 (10.2 %) were considered as stable, probably fused, and 2 (2.6 %) of the operated levels were diagnosed as pseudarthrosis. When stratified by type of graft material complete fusion was obtained in 75 % of patients in which autograft was used to fill the cages, compared to 89 % of patients in which calcium triphosphate was used, and 83 % of patients in which Attrax™ was used.


Reports of XLIF fusion rate in the literature vary from 85 to 93 % at 1-year follow-up. Fusion rate in our series corroborates data from previous publications. The results of this series confirm that anterior inter body fusion by means of XLIF approach is a technique that achieves high fusion rate and satisfactory clinical outcomes.


Anterior interbody fusion Fusion rate XLIF DLIF LLIF Transpsoas Minimally invasive spine surgery 


Conflict of interest

Pedro Berjano and Claudio Lamartina have received honorarium from Nuvasive, DePuy Synthes, Medacta, K2M as lecturers and for surgeon education activities.


  1. 1.
    Cecchinato R, Berjano P, Bassani R, Sinigaglia A, Lamartina C (2014) How do interbody devices affect sagittal plane alignment. J Neurosurg Sci 58:87–90PubMedGoogle Scholar
  2. 2.
    Berjano P, Balsano M, Buric J, Petruzzi M, Lamartina C (2012) Direct lateral access lumbar and thoracolumbar fusion: preliminary results. Eur Spine J 21(Suppl 1):S37–S42CrossRefPubMedGoogle Scholar
  3. 3.
    Berjano P, Lamartina C (2013) Far lateral approaches (XLIF) in adult scoliosis. Eur Spine J 22(Suppl 2):S242–S253CrossRefPubMedGoogle Scholar
  4. 4.
    Youssef J, McAfee P, Patty C, Raley E, DeBauche S, Shucosky E, Chotikul L (2010) Minimally invasive surgery: lateral approach interbody fusion. Spine 35(26S):S302–S311CrossRefPubMedGoogle Scholar
  5. 5.
    Formica M, Berjano P, Cavagnaro L, Zanirato A, Piazzolla A, Formica C (2014) Extreme lateral approach to the spine in degenerative and post traumatic lumbar diseases: selection process, results and complications. Eur Spine J 23(Suppl 6):684–692CrossRefPubMedGoogle Scholar
  6. 6.
    Rodgers W, Gerber E, Patterson J (2010) Fusion after minimally disruptive anterior lumbar interbody fusion: analysis of extreme lateral interbody fusion by computed tomography. SAS J 4(2):63–66CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Malham G, Ellis N, Parker R, Seex K (2012) Clinical outcome and fusion rates after the first 30 extreme lateral interbody fusions. Sci World J 2012:246989. doi: 10.1100/2012/246989 CrossRefGoogle Scholar
  8. 8.
    Bridwell K, Lenke L, McEnery Baldus C, Blanke K (1995) Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Spine 20(12):1410–1418PubMedGoogle Scholar
  9. 9.
    Choudhri TF, Mummaneni PV, Dhall SS, Eck JC, Groff MW, Ghogawala Z, Watters WC 3rd, Dailey AT, Resnick DK, Sharan A, Wang JC, Kaiser MG (2005) Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: radiographic assessment of fusion. J Neurosurg Spine 2:653–657CrossRefPubMedGoogle Scholar
  10. 10.
    Tan G, Goss B, Thorpe P, Williams R (2007) CT-based classification of long spinal allograft fusion. Eur Spine J 16(11):1875–1881CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Pedro Berjano
    • 1
  • Francesco Langella
    • 4
  • Marco Damilano
    • 1
  • Matteo Pejrona
    • 1
  • Josip Buric
    • 1
  • Maryem Ismael
    • 1
    Email author
  • Jorge Hugo Villafañe
    • 3
  • Claudio Lamartina
    • 2
  1. 1.IVth Spine Surgery DivisionIRCCS Istituto Ortopedico GaleazziMilanItaly
  2. 2.IInd Spine Surgery DivisionIRCCS Istituto Ortopedico GaleazziMilanItaly
  3. 3.IRCCS Don Gnocchi FoundationMilanItaly
  4. 4.Orthopaedic DivisionIInd University of NaplesNaplesItaly

Personalised recommendations