Extreme lateral interbody fusion (XLIF) approach for L5-S1: Preliminary experience

Junjie Xu; Enliang Chen; Le Wang; Xiaobao Zou; Chenfu Deng; Junlin Chen; Rencai Ma; Xiangyang Ma; Zenghui Wu

doi:10.3389/fsurg.2022.995662

Extreme lateral interbody fusion (XLIF) approach for L5-S1: Preliminary experience

Front Surg. 2022 Sep 27:9:995662. doi: 10.3389/fsurg.2022.995662. eCollection 2022.

Authors

Junjie Xu^{1

2}, Enliang Chen³, Le Wang⁴, Xiaobao Zou², Chenfu Deng^{1

2}, Junlin Chen^{1

2}, Rencai Ma^{1

2}, Xiangyang Ma², Zenghui Wu^{1

2}

Affiliations

¹ The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
² Department of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou, China.
³ Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, China.
⁴ Department of Orthopedics, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Abstract

Study design: Technical report.

Objective: Evaluate technical feasibility of extreme lateral interbody fusion (XLIF) at the L5-S1 level and provide an elaborate description of the surgical technique.

Summary of background data: With the development of surgical techniques, the indications for oblique lumbar interbody fusion (OLIF) surgery have been broadened to the L5/S1 segment. However, this technique also has limitations. Different from OLIF, the L5/S1 segment used to be considered the main contraindication for XLIF. To date, no authors have reported the application of XLIF at the L5/S1 level.

Methods: Only patients whose preoperative lumbar MRI showed the position of the psoas major muscles and blood vessels at the L5/S1 level were similar to those seen at supra-L5 levels were seleted. By folding the operating table, the iliac crest was moved downward to expose the L5/S1 intervertebral space during the operation. The remaining surgical procedures were consistent with routine XLIF surgery.

Results: 8 patients successfully underwent XLIF at the L5/S1 level. The L5/S1 disk spaces were always exposed sufficiently for disk preparation and cage insertion. The post operative radiographs showed a satisfactory L5/S1 reconstruction with good cage position. Only 1 patient (12.5%) felt thigh numbness, and the symptoms gradually resolved after surgery and were no longer present in a month. There were no cases of psoas hematoma, retrograde ejaculation or vascular injury. The postoperative VAS score showed that all the patients achieved satisfactory results.

Conclusions: XLIF at L5-S1 is feasible in strictly selected cases after thorough preoperative preparation and careful intraoperative procedures. However, we did not recommend XLIF as a routine surgical option at the L5/S1 level.

Keywords: L5-S1; XLIF; iliac crest; iliac vessels; lumbar plexus; surgical technique.