Lateral lumbar interbody fusion (LLIF)

Last revised by Dr Henry Knipe on 11 Aug 2021

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.

See: lumbar interbody overview (overview).

  • 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

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.

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Cases and figures

  • Figure 1: surgical approach
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  • Case 1
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