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What is Extreme Lateral Interbody Fusion (XLIF)?

Extreme lateral interbody fusion (XLIF) is a surgical procedure in which the front part of the lumbar spine is fused from the side. The surgeon makes an incision in the side between the lower ribs and the pelvis. Instruments pass through muscles and to the disc. Disc material is removed and a fusion graft is placed into the disc space. The graft is usually bone or a cage combined with bone.

XLIF is most commonly performed for the treatment of painful disc degeneration or disruption. It may also be used in the treatment of other spinal conditions.



Once you have decided to have lateral fusion surgery, the following events take place:

  • A medical examination.
  • Chest X-ray, EKG and blood work.
  • You may be asked to have a neurological or psychological examination.
  • If taking aspirin or anti-inflammatory medications daily, stop these medications at least one week before lateral fusion surgery.
  • If you take prescription medications or other drugs, including herbals, ask your doctor how soon before lateral fusion surgery you should stop taking these.
  • Do not have anything to eat or drink for 6 to 8 hours before surgery.
  • You will check into the hospital the morning of surgery.
  • Prior to surgery, you will be asked to sign permits for surgery, anesthesia, blood and blood products.
  • You will be positioned on your side.
  • An incision is made in the side between the lower ribs and pelvis.
  • Fluoroscopy (live X-ray) is used to determine the correct level(s) to be operated.
  • The disc is approached after passing instruments through muscle layers.
  • Disc tissue is removed.
  • A fusion cage and/or bone graft is placed in the disc space.
  • Normal compression of the spine will hold the bone or cage in place.
  • Sometimes pedicle screws are placed to provide additional stability (see PLF) or a plate is placed on the side of the spine.
  • Lateral Fusion Surgery takes approximately 1-3 hours.
  • You will be in the recovery room from 1 to 1½ hours.
  • The surgeon will contact your family while you are in recovery.
  • After going to a hospital room, you will be able to use a PCA pump to get medication for pain control. This machine controls the amount of medication that can be received.
  • Staff will usually get you out of bed the same day as the lateral fusion surgery.
  • The hospital stay is usually 2-3 days.
  • A brace or corset is prescribed to restrict bending and promote healing of the fused area.
  • You will be given any needed prescriptions and discharge instructions.
  • A set of exercises that you can do at home will be provided.
  • You will be able to ride in a car or plane upon leaving the hospital.
  • It is important to avoid twisting and bending backward.
  • Physical therapy is usually initiated after the first office visit with your doctor following surgery.
  • Recovery from XLIF varies greatly among patients and is dependent on the extent of the surgery as well as the age and health of the individual. Return to work also varies greatly among patients and is related to overall health and the type of work you do. It is important to note that back pain is seldom completely eliminated – the objective with fusion surgery is to reduce pain.
Acute Pain in the back