Fusion of the L5-S1 Segment in Degenerative Lumbar Spine Disease Using the Extreme Lateral Interbody Fusion Technique: A Case Report Study

Abstract

Study design: This study is a single center case report study with 3 cases of degenerative lumbar spine disease treated with the XLIF procedure at the level L5-S1. Objective:The purpose of this case report study is to demonstrate the possibility of treating degenerative lumbar spine disease at the level L5-S1 using the XLIF procedure.Summary and Background of Data: There are several standard surgical techniques for the treatment of degenerative lumbar spine diseases that have failed conservative treatment. Interbody fusion can restore the proper alignment of the spine hereby leading to indirect decompression of the nerve roots. The XLIF procedure is a relatively recent retroperitoneal and transpsoas major muscle approach allowing the insertion of interbody implants. This approach has shown good results but for anatomical reasons it is limited at the lumbar spine to the segments L1-L5.Methods: A single center case report study with 3 cases of degenerative lumbar spine disease treated with the XLIF procedure at the level L5-S1.Results: All 3 patient were successfully operated at the level L5-S1 with an XLIF procedure. Conclusion:This case series suggests that the XLIF procedure is a safe, feasible and timesaving procedure to treat the segment L5-S1 in selected patients with severe degenerative lumbar spine disease and failed conservative

Extreme Lateral Interbody Fusion (XLIF) Including the Segment L5/S1 for Multi-level Lumbar Spondylodesis

“…This assessment was based on the preoperative standing lateral radiograph, with the iliac crest located below the vertical midline of the L5 vertebra. The anatomy of the iliac vessels was analysed based on preoperative MRI, and their relation to neural structures was described in our prior study [10]. In the 24 patients, interbody fusion was performed in 60 total levels.…”

“…2 The L5/S1 segment was formerly thought to be contraindicated for the XLIF approach due to anatomical considerations of the iliac crest, iliac vessels, and the exiting L5 nerve root. Because of this, only a small number of cases involving the L5-S1 segment operated by have been documented in the literature [10,11] In order to further broaden the application of XLIF and to show that this is a reliable and reproducible operation in the segment L5/S1, we present 24 cases of multilevel degenerative instability of the lumbar spine treated with XLIF procedures including the L5/S1 level.…”