Sydney Brain & Spine


What is XLIF – Lateral Access Surgery?

The (eXtreme Lateral Interbody Fusion) procedure is a minimally disruptive surgical technique in which the surgeon approaches the spine from the side of the patient’s body, rather than the front or back as in traditional spine surgeries. This side (lateral) approach can reduce the risk of injury to muscles, nerves, and blood vessels.

The XLIF technique can provide relief to patients who cannot tolerate traditional open back surgery due to increased risks of longer anaesthesia time, greater blood loss, longer hospitalisation, and slower recovery.

XLIF surgery is a less disruptive alternative for patients who have lived with back or leg pain through years of various failed treatments, including steroid injections, physical therapy, and pain medication.

Benefits of XLIF

For many patients, benefits include:

  • Reduced blood loss and scarring. Less-invasive procedure allows for less tissue disruption, resulting in reduced blood loss.
  • Less pain — Because the surgeon accesses the intervertebral disc space from the patient’s side, XLIF does not disrupt sensitive back muscles, bones or ligaments. Many patients are able to walk the same day after surgery.
  • Shorter hospital stay. Patients usually require a stay of one to three days in the hospital, compared to three to six days of immobility and hospitalisation in traditional open approaches.
  • Faster return to normal activity. Many XLIF patients walk the same day they have surgery, although full recovery takes a few months

Conditions Treated

XLIF may be recommended to treat the following lumbar or lower spine disorders:

  • Adjacent level syndrome, a condition that develops adjacent to the site of a previous fusion surgery
  • Degenerative disc disease with instability
  • Degenerative scoliosis, a right or left curvature of the spine
  • Degenerative spodilolysthesis which occurs when a vertebrae slips forward over another vertebrae
  • Posterior pseudoarthrosis, a previous fusion surgery that did not fuse correctly
  • Post-laminectomy syndrome, an instability of the spine that occurs after a previous non-fusion surgery
  • Recurring disc herniation

XLIF is not recommended for patients with the following conditions:

  • Degenerative spondylolisthesis greater than grade 2. This is defined as one vertebra being displaced more than 50 percent off the adjacent vertebra
  • Need for direct nerve decompression, when a patient has a nerve that is so severely pinched that the surgeon must directly free it during surgery. XLIF alone will not adequately solve the problem.
  • Retroperitoneal scarring, or scarring behind the abdominal cavity, on both left and right sides of the spine due to abscess or prior surgery
  • Symptoms in the L5-S1 level of the spine
  • Certain lumbar deformities

What Can You Expect During XLIF Surgery?


During XLIF, surgeons work in areas that are close to nerves on the spinal column. To prevent nerve damage, nerve monitoring, called electromyography or EMG, is used that provides surgeons with real-time information about nerve position relative to his or her instruments.

XLIF is performed under general anaesthesia so you’ll be asleep during surgery. Steps of the surgery include:

  • Once you are asleep, you will be positioned on your side. The surgeon will use X-ray to locate the disc to remove and will use a marker to mark your skin above the disc.
  • A small incision is first made toward your back. The surgeon places his or her finger through this incision to protect the peritoneum (sac containing abdominal organs) as instruments pass through the lateral space to the spine.
  • A second incision is made on your side through which the instruments will pass to remove the herniated disc.
  • Special instruments, called tubular dilators, will be inserted through the muscle on the side of the vertebrae. X-rays and nerve monitoring will safely guide instruments to the appropriate location and away from nerves.
  • After tubular dilators are placed, a tissue retractor is placed over them, locked to the surgical table and held open to stretch the small incisions and provide light and instrument access to the disc space.
  • With the spinal disc visible, the disc is removed.
  • An implant is placed into the empty disc space. The implant is filled with bone graft for fusion.
  • An X-ray image ensures the implant is correctly placed. The retractor is removed and the small incisions are closed with a few stitches and a bandage.

Depending on a patient’s condition, additional support, such as screws, plates or rods, may be inserted to stabilize the spine for fusion.

Advantages of the lateral approach

The XLIF procedure does not require entry through back muscles, bones, or ligaments, resulting in less postoperative pain. It also allows for complete disc removal and implant insertion, compared with approaches from the back. When compared to ALIF, where the surgeon enters from the front, the XLIF

procedure offers the benefit of reducing the risk of vascular injury during the procedure.


Because XLIF is less disruptive than conventional surgery, most patients can walk the evening after surgery and are discharged from the hospital within a few days.

Your surgeon and health care team will determine the best course for you, depending on your comfort and other health problems you might have. Your surgeon will discuss with you any appropriate pain medications as well as a prescribed program of activities. In general, XLIF surgery results in quick recovery and return to normal activities.


Possible risks and complications include:

  • Deep vein thrombosis or clotting
  • Failure for the implant to fuse
  • Infection
  • Injury to blood vessels
  • Muscle weakness
  • Nerve or spinal cord damage
  • Persistent pain at the site of bone graft harvest in the hip
  • Pneumonia
  • Progression of existing spinal disease
  • Stroke
  • Urinary tract infection