This is also a “minimally invasive” procedure for lumbar spinal stenosis. This technique is utilized when the stenosis is caused by or associated with scoliosis, instability (spondylolisthesis) or severe disc degeneration. A 1-inch incision is placed on the side, the intervertebral disc is removed and a plastic spacer is inserted between the vertebral bodies to distract the adjacent vertebrae and relieve the pressure on the nerves.

This procedure can take 30 to 120 minutes depending on the extent of spinal stenosis. Most patients stay overnight and go home the following day. For patients with severe scoliosis, this is also an excellent method to achieve deformity correction without the extensive pain, operative time and blood loss associated with traditional scoliosis surgery. For patients with severe scoliosis and others with osteoporotic bone, screws may also need to be placed to achieve absolute stabilization. Even so, these screws are placed in a minimally invasive fashion through 1-cm incisions on the back. Whether or not a patient needs screws is dependent on an individual’s bone quality, pathology and other medical conditions. It is generally discussed preoperatively.

Direct Lateral Approach

The patient in the above radiograph is a 62 year old female who underwent a posterior fusion 12 years ago. She developed stenosis with a degenerative disc at the level above the fusion. Note the flattened disc space on the radiograph on the left; note how the XLIF spacer restored the disc height on the radiograph on the right. She underwent the XLIF procedure for this problem. The surgery took 30 minutes and she went home the next day with a minimal amount of “soreness” at the incision site. She had immediate of her leg pain, numbness and tingling.

Direct Lateral Approach

This 72 year old woman underwent a minimally invasive fusion (utilizing the XLIF procedure) for lumbar spinal stenosis and scoliosis. She had one small incision on the side for the XLIF procedure and several very small incisions on the back for each screw. She was in the hospital for 4 days before going home (XLIF on Monday and the screws on Wednesday before being discharged on Friday). She lost a minimal amount of blood and did NOT need a blood transfusion. She was walking independently the day after each procedure. The radiograph on the left shows her scoliosis before the surgery and the radiograph on the right demonstrates her curve after surgery.

What happens after the surgery?

Patients are allowed to get out of bed and walk independently within a couple of hours of the operation. The overwhelming majority of patients experience significant, if not complete relief of the leg pain, numbness, tingling, etc. There is some pain at the incision site but it is generally well controlled with pain medication. Patients with a X-STOP or an XLIF usually go home the next day. Patients undergoing a laminectomy alone go home in 1-3 days while those with a laminectomy and open posterior fusion go home in 2-4 days. All patients are able to walk on their own and are independent in their activities of daily living (eating, drinking, personal hygiene, etc) when they go home.

Most patients are off all pain medications within a few days to a few weeks depending on their specific procedure. Within a few days after surgery, patients are allowed to resume all activities without restrictions (with common sense being the guiding principle); however, we also give each patient specific written instructions on the level of activity. There are individual exceptions to this and are discussed on an individual basis.