Our Summary

This study assessed the effectiveness and safety of a surgical technique called extreme lumbar interbody fusion (XLIF) in revising previous spinal surgeries. The researchers examined past cases where patients had undergone XLIF as a method of surgical correction, and collected data on patient demographics, associated health conditions, surgical details, clinical results, and any complications during or after surgery.

They studied 36 patients who were observed for at least 28 months after surgery. In these patients, 41 spinal levels were treated using XLIF. On average, these patients had undergone 1.5 previous spinal surgeries. The study found significant improvements in back and leg pain, as measured on the VAS scale, and in the overall disability index, or ODI score.

There were some complications - one patient experienced a fractured vertebral endplate during the surgical process, and about 14% of patients reported temporary weakness in the thigh muscles and reduced sensation in the front of the thigh, which resolved within three months after surgery. In one case, a patient experienced temporary pain radiating down the opposite side of the body. However, there were no cases of implant failure at the final follow-up.

In conclusion, the study suggests that XLIF is a reasonably safe and effective technique for revising spinal surgeries, with the added benefit of reducing the risks associated with conventional posterior fusion techniques, like nerve root damage, postoperative pain radiating down the limbs, and tears in the outermost layer of the spinal cord and brain.

FAQs

  1. What is an extreme lumbar interbody fusion (XLIF) and when is it used in spinal revision surgery?
  2. What were the clinical outcomes and complications of XLIF reported in the study?
  3. How does XLIF compare to other fusion techniques in terms of safety and effectiveness?

Doctor’s Tip

One helpful tip a doctor might tell a patient about spinal fusion is to follow the post-operative care instructions carefully, including proper lifting techniques, maintaining good posture, and attending physical therapy sessions as recommended. It’s important to allow time for proper healing and to gradually increase activity levels as advised by your healthcare provider. Remember to communicate any concerns or changes in symptoms to your doctor promptly to ensure the best possible outcome.

Suitable For

Patients who are typically recommended spinal fusion include those with failed back surgery, degenerative disc disease, spondylolisthesis, spinal stenosis, scoliosis, spinal fractures, and other spinal deformities or abnormalities. Spinal fusion may also be recommended for patients who have not had success with conservative treatments such as physical therapy, medications, and injections.

Timeline

  • Patient undergoes spinal fusion surgery, specifically extreme lumbar interbody fusion (XLIF), as a revision surgery due to failed previous spine surgeries.
  • Surgery involves fusing 41 levels with XLIF, with a mean number of 1.5 previous spine surgeries.
  • Postoperatively, patients experience significant improvement in back and leg pain, as well as in the Oswestry Disability Index (ODI) score.
  • Intraoperative complications include one vertebral endplate fracture during interbody space preparation.
  • Postoperative complications include quadriceps weakness and anterior thigh hypoesthesia in 13.8% of patients, which fully recover within 3 months. One case of transient contralateral radiculopathy is observed.
  • No implant failure is detected at final follow-up, indicating XLIF as a safe and effective fusion technique in revision surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with spinal fusion surgery, specifically extreme lumbar interbody fusion (XLIF)?
  2. How will spinal fusion surgery improve my back and leg pain?
  3. What is the success rate of XLIF in revision surgery compared to other fusion techniques?
  4. How long is the recovery process after spinal fusion surgery?
  5. Will I need physical therapy after spinal fusion surgery?
  6. Are there any restrictions or limitations on my activities after spinal fusion surgery?
  7. How long will I need to follow up with you after the surgery?
  8. What steps can I take to ensure the best possible outcome from spinal fusion surgery?
  9. Are there any alternative treatments or procedures that I should consider before undergoing spinal fusion surgery?
  10. What is the likelihood of needing additional surgery in the future after spinal fusion surgery?

Reference

Authors: Formica M, Zanirato A, Cavagnaro L, Basso M, Divano S, Felli L, Formica C. Journal: Eur Spine J. 2017 Oct;26(Suppl 4):464-470. doi: 10.1007/s00586-017-5115-6. Epub 2017 May 9. PMID: 28488095