Advertisement

HSS Journal ®

, Volume 9, Issue 1, pp 25–31 | Cite as

Extreme Lateral Interbody Fusion (XLIF) in the Thoracic and Thoracolumbar Spine: Technical Report and Early Outcomes

  • Dennis S. MeredithEmail author
  • Christopher K. Kepler
  • Russel C. Huang
  • Vishal V. Hegde
Original Article

Abstract

Background

Previous studies have demonstrated the distinct advantages of thoracoscopically assisted spinal fusion compared to traditional open thoracotomy. However, these techniques are limited by a steep learning curve, prolonged operative time, and lack of three-dimensional visualization of the surgical field.

Objective

The objective of this study was to describe our initial experience with an adaptation of the extreme lateral interbody fusion (XLIF) technique allowing access to the anterior aspect of the thoracic and thoracolumbar spine with specific reference to (1) early pulmonary complications, (2) non-pulmonary complications, and (3) ability of this technique to successfully achieve spinal decompression and fusion at the operative level.

Methods

Clinical and radiographic data were reviewed for the entire perioperative period. A total of 18 patients (72% females; mean age, 56.8 years) underwent a thoracic XLIF procedure for spinal pathologies including disc herniation, fracture, tumor, pseudoarthrosis, and proximal junctional kyphosis. A total of 32 levels were treated, with the majority located at the thoracolumbar junction. Twelve of the procedures were done as part of a combined anterior/posterior surgery.

Results

The mean estimated blood loss was 577 ml and the mean length of stay was 12 days. At a mean follow-up of 14 months, all patients except for one (who died of widely metastatic disease) had achieved radiographic evidence of fusion. Two patients developed pulmonary effusions requiring medical intervention. Six patients had seven non-pulmonary complications: incidental durotomy (two), infection (one), instrumentation pullout (one), cardiac arrhythmia (two), and death from metastatic disease (one).

Conclusions

The XLIF technique can be utilized for access to the anterior column of the thoracic and thoracolumbar spine. 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.

Keywords

spine thoracolumbar spine XLIF lateral access surgery 

Notes

Disclosures

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained.

References

  1. 1.
    Beisse R, Muckley T, Schmidt MH, Hauschild M, Buhren V. Surgical technique and results of endoscopic anterior spinal canal decompression. J Neurosurg Spine. 2005;2:128-36.PubMedCrossRefGoogle Scholar
  2. 2.
    Beisse R, Muckley T, Schmidt MH, et al. Surgical technique and results of endoscopic anterior spinal canal decompression. J Neurosurg Spine. 2005;2:128-136.PubMedCrossRefGoogle Scholar
  3. 3.
    Benglis D, Wang MY, Levi AD. A comprehensive review of the safety profile of bone morphogenetic protein in spine surgery. Neurosurgery. 2008;62:ONS423-31.CrossRefGoogle Scholar
  4. 4.
    Edwards CC, Bridwell KH, Patel A, Rinella AS, Berra A, Lenke LG. Long adult deformity fusions to L5 and the sacrum. A matched cohort analysis. Spine. 2004;29:1996-2005.PubMedCrossRefGoogle Scholar
  5. 5.
    Emami A, Deviren V, Berven S, Smith JA, Hu SS, Bradford DS. Outcome and complications of long fusions to the sacrum in adult spine deformity. Spine. 2002;27:776-86.PubMedCrossRefGoogle Scholar
  6. 6.
    Han PP, Kenny K, Dickman CA. Thorascopic approaches to the thoracic spine: experience with 241 surgical procedures. Neurosurgery. 2002;51:S88-S95.PubMedCrossRefGoogle Scholar
  7. 7.
    Huang TJ, Hsu RW, Li YY, Cheng CC. Minimal access spinal surgery (MASS) in treating thoracic spine metastasis. Spine. 2006;31:1860-1863.PubMedCrossRefGoogle Scholar
  8. 8.
    Karikari IO, Nimjee SM, Hardin CA, et al. Extreme lateral interbody fusion approach for isolated thoracic and thoracolumbar spine diseases: Initial clinical experience and early outcomes. J Spinal Disord Tech. 2011;24:368-75.Google Scholar
  9. 9.
    Kepler CK, Huang RC, Meredith D, Cunningham M, Boachie-Adjei O. Delayed pleural effusion after anterior thoracic spinal fusion using bone morphogenetic protein-2. Spine. 2011;36:E365-9.PubMedGoogle Scholar
  10. 10.
    Khoo LT, Beisse P, Potulski M. Thorascopic-assisted treatment of thoracic and lumbar fractures: a series of 371 consecutive cases. Neurosurgery. 2002;51:S104-117.PubMedGoogle Scholar
  11. 11.
    Kossmann T, Jacobi D, Trentz O. The use of a retractor system (SynFrame) for open, minimal invasive reconstruction of the anterior column of the thoracic and lumbar spine. Eur Spine J. 2001;10:396-402.PubMedCrossRefGoogle Scholar
  12. 12.
    Landreneau RJ, Hazelrigg SR, Mack MJ, et al. Postoperative painrelated morbidity: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 1993;56:1285-9.PubMedCrossRefGoogle Scholar
  13. 13.
    Lidar Z, Lifshutz J, Bhattacharjee S, Kurpad SN, Maiman DJ. Minimally invasive, extracavitary approach for thoracic disc herniation: technical report and preliminary results. Spine J. 2006;6:157-63.PubMedCrossRefGoogle Scholar
  14. 14.
    Lonner BS, Auerbach JD, Estreicher MB, et al. Pulmonary function changes after various anterior approaches in the treatment of adolescent idiopathic scoliosis. J Spinal Disord Tech. 2009;22:551-8.Google Scholar
  15. 15.
    Lubelski D, Abdullah KG, Steinmetz MP, et al. Lateral extracavitary, costotransversectomy, and transthoracic thoracotomy approaches to the thoracic spine: review of techniques and complications. J Spinal Disord Tech. 2011. doi: 10.1097/BSD.0b013e31823f3139.
  16. 16.
    Mack MJ, Regan JJ, Bobechko WP, et al. Application of thorascopy for diseases of the spine. Ann Thorac Surg. 1993;56:736-8.PubMedCrossRefGoogle Scholar
  17. 17.
    Mayer HM. Microsurgical anterior approach to T5-T10 (Mini- TTA). In: Mayer HM, ed. Minimally Invasive Spine Surgery. 2nd ed. Berlin: Springer; 2006:129-37.CrossRefGoogle Scholar
  18. 18.
    Ozgur BM. Aryan He, Pimenta L et al. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J. 2006;6:435-43.PubMedCrossRefGoogle Scholar
  19. 19.
    Rosenthal D. Endoscopic approaches to the thoracic spine. Eur Spine J. 2000;9:S8-16.PubMedCrossRefGoogle Scholar
  20. 20.
    Smucker JD, Rhee JM, Singh K, et al. Increased swelling complications associated with off-label usage of rhBMP-2 in the anterior cervical spine. Spine. 2006;31:2813-9.PubMedCrossRefGoogle Scholar
  21. 21.
    Tis JE, O'Brien MF, Newton PO, et al. Adolescent idiopathic scoliosis treated with open instrumented anterior spinal fusion: five-year follow-up. Spine. 2010;35:64-70.Google Scholar

Copyright information

© Hospital for Special Surgery 2013

Authors and Affiliations

  • Dennis S. Meredith
    • 1
    Email author
  • Christopher K. Kepler
    • 2
  • Russel C. Huang
    • 1
  • Vishal V. Hegde
    • 3
  1. 1.Spine and Scoliosis Service, Department of Orthopedic SurgeryHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Orthopedic SurgeryThomas Jefferson University Hospital and Rothman InstitutePhiladelphiaUSA
  3. 3.Weill Cornell Medical CollegeNew YorkUSA

Personalised recommendations