Clinical Results and Utility of Extreme Lateral Interbody Fusion System for Revision Spine Surgery

Presented at SMISS Annual Forum 2016
By Yukihiro Nakagawa MD, PhD
With Munehito Yoshida MD, PhD, Hiroshi Yamada MD, PhD, Hiroshi Hashizume MD, PhD, Akihito Minamide MD, PhD, Hiroshi Iwasaki MD, PhD, Shunji Tsutsui MD, PhD, Masanari Takami , Shinichi Nakao ,

Disclosures: Yukihiro Nakagawa MD, PhD Munehito Yoshida MD, PhD , Hiroshi Yamada MD, PhD None, Hiroshi Hashizume MD, PhD None, Akihito Minamide MD, PhD , Hiroshi Iwasaki MD, PhD None, Shunji Tsutsui MD, PhD , Masanari Takami None, Shinichi Nakao None,


Lateral lumbar interbody fusion (LLIF) bring a new strategy for fusion or correction surgery of degenerative disease or spinal deformity. Use LLIF and percutaneous pedicle screw (PPS) avoid direct spinal canal decompression. Therefore, this technique is expected for revision spine surgery. 


To report the clinical results and utility of eXtreme Lateral Interbody Fusion (XLIF) for revision spine surgery after decompression only surgery. 


From 2013, we performed 78 XLIF surgeries, among them, 22 cases (9 males and 13 females, mean 70.9years) were revision cases (XLIF group). All of them had been underwent decompression only surgery. Nineteen cases used by PPS system and 3 cases used by open method. 17 revision spine surgeries cases used by posterior lumbar interbody fusion (PLIF) or posterolateral fusion (PLF) in the same period were used for control group. Control group were all open method and required direct decompression of the spinal canal. Clinical status were evaluated by visual analogue scale (VAS) for low back pain, Roland-Morris disability questionnaire and patient satisfaction score. Perioperative complication, blood loss, operative time, area of the spinal canal were evaluated. 


VAS for low back pain improved from 58 to 25 in XLIF group and from 71 to 36 in control group. RDQ were from 10.8 to 6.7 in XLIF group and from14.7 to 8.4 in control group. Patient satisfaction is 76.1% in XLIF group and 66.5% in control group. Blood loss and operative time were 55 minutes and 28.6ml in XLIF group, and 152 minutes and 141 ml in control group. Area of spinal canal increased in both group. % increase was 149% in XLIF group and 176% in control group. Thigh problems were recognized for 6 cases in XLIF group, but no major complication. Three dural tear were recognized in control group. 


In general, revision surgery has a potential risk of a long operative time, blood loss and complications for direct decompression. Revision surgery using XLIF and PPS can perform minimally invasive interbody fusion and avoid direct decompression. Indirect decompression was effective (% increase of canal area; 149% in revision group, no additional surgery). This procedure is also expected for revision surgery in high risk patient and obese patient. Revision surgery after decompression surgery is a good indication for XLIF and PPS.