XLIF - Extreme Lateral Interbody Fusion

INDICATIONS
  • x
POSITION
  • Lateral decubitus
  • Tape above and below, across legs
  • Jack-knife table (rib cage & ilac crest open to increase access inferiorly to disc)
MARK
  • Disc space
  • Superior aspect of iliac crest
  • Fluoro: cross table AP to confirm that pt’s spine perpendicular to floor w/o rotation
ROOM
  • Stand same side as attending
INCISION
  • Lateral
BLUNT DISSECTION
  • Finger down to abdominal wall fascia, through RP space, in petit’s triangle
  • Sweeping away RP fat, palpate psoas muscle, medial iliac crest, medial last rib
  • Palpate inner surface of abdominal wall (fingers able to touch through wall)
EXPOSURE
  • Goal: into  disc space
  • Small black dilator (with monitor) in with finger to protect through psoas
  • Monitor
    NuVasive
    Acceptable >11
    Ideal >20
  • Fluoro/xray to confirm
  • K wire through initial dilator
  • Additional dilators (purple, green) – w/ monitoring 
  • (with purple lever arm, saw teeth lock down)
    Open up disc space (squeeze level arm close to me)
    Lever closer to incision ?
    Remove two purple wings (close to attending)
DECOMPRESSION
  • Intradiscal distraction, anterior releasing
  • Knife, kerosene, pituitary
  • Sizer cage 
  • Saw edges of endplate w/ rasp, curette
  • Cage (flat end towards attending)
  • Place cage stuffed w/ BMP, down w/ hammer
  • Fluoro
CLOSURE
  • Irrigation, close lumbosacral fascia
  • JP drain (18)