Lateral lumbar interbody fusion (LLIF)
Citation, DOI and article data
Lateral lumbar interbody fusion (LLIF), also commonly known by the proprietary names eXtreme Lateral Interbody Fusion (XLIF) or Direct Lateral Interbody Fusion (DLIF) 3, is one of many approaches to lumbar interbody fusion and is performed from T12/L1 to L4/5.
- L5/S1 operative level (iliac crests block lateral access)
- prior extensive retroperitoneal surgery
- sacralized L5 when operating at L4/5
- osteoporosis (relative) 4,5
Unlike an ALIF, an LLIF is performed from a lateral transpsoas approach and does not require retroperitoneal or intraperitoneal dissection. The disc space is reached and a discectomy is performed. Into the defect is introduced a disc spacer cage and bone graft material which will, in time, result in complete bony fusion 1,2. The newer XLIF and DLIF techniques allow a minimally-invasive approach. Neuromonitoring can be used in the XLIF technique 4.
- fusion rates of ~97% are reported 4
History and etymology
This technique was developed in the early 2000s to be a safer alternative to the older anterior lumbar interbody fusion (ALIF), which was developed in the 1950s 1,2.
- 1. Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. (2006) The spine journal : official journal of the North American Spine Society. 6 (4): 435-43. doi:10.1016/j.spinee.2005.08.012 - Pubmed
- 2. Berjano P, Gautschi OP, Schils F, Tessitore E. Extreme lateral interbody fusion (XLIF®): how I do it. (2015) Acta neurochirurgica. 157 (3): 547-51. doi:10.1007/s00701-014-2248-9 - Pubmed
- 3. Salzmann SN, Shue J, Hughes AP. Lateral Lumbar Interbody Fusion-Outcomes and Complications. (2017) Current reviews in musculoskeletal medicine. 10 (4): 539-546. doi:10.1007/s12178-017-9444-1 - Pubmed
- 4. David S. Xu, Corey T. Walker, Jakub Godzik, Jay D. Turner, William Smith, Juan S. Uribe. Minimally invasive anterior, lateral, and oblique lumbar interbody fusion: a literature review. (2018) Annals of Translational Medicine. 6 (6): 7. doi:10.21037/atm.2018.03.24
- 5. Ralph J. Mobbs, Kevin Phan, Greg Malham, Kevin Seex, Prashanth J. Rao. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. (2015) Journal of Spine Surgery. doi:10.3978/j.issn.2414-469X.2015.10.05