Lateral Lumbar Interbody Fusion (LLIF/XLIF/OLIF)

What is lateral lumbar interbody fusion or LLIF?

Spinal fusion is a type of surgery performed to treat back pain caused by injuries, degenerative diseases, or other issues with the intervertebral discs in the spine. Lateral lumbar interbody fusion (LLIF) is a type of spinal fusion surgery where two or more vertebrae are fused together to potentially alleviate back pain and decompress the nerves and nerve roots.  LLIF is considered a minimally invasive surgery where the spine is accessed through a 2 to 5 cm incision on the patient’s side, as opposed to an incision made on the patient’s back. Brenton Pennicooke, MD, board certified spinal neurosurgeon, treats patients in St. Louis, St, Peters, Creve Coeur and surrounding cities in St. Louis county and St. Charles county, Missouri who may need a lateral lumbar interbody fusion due to lower back pain or a spinal condition in the lumbar spine.

What is XLIF?

Extreme lateral interbody fusion (XLIF), is trademarked term occasionally used to describe the lateral lumbar interbody fusion (LLIF) procedure. These two terms describe the same type of surgery, where surgical tools enter the region near the spine through an incision on the side of the body. These tools pass through the back of the abdomen, and through the psoas muscle along the spinal column to reach the spine. This less invasive approach allows the strong back muscles to remain fully intact.

What is OLIF?

Oblique lateral interbody fusion (OLIF) is also a trademarked term and describes a surgical technique that is very similar to lateral lumbar interbody fusion, but incisions are made in a slightly different location. In LLIF or XLIF surgery, the spine is accessed through surgical incisions made directly to the side of the patient. In OLIF, the incision is at a position that is slightly more to the front of the body, approximately halfway between the naval and the direct side of the body. Abdominal organs are slightly moved to allow surgical tools to reach the spine, and OLIF surgery is allows for less disruption of the psoas muscle.

Which spinal conditions can be helped with LLIF?

Many conditions can be helped or treated with lateral lumbar interbody fusion including, but not limited to:

• Degenerative Disc Disease
• Spondylolisthesis
• Scoliosis
• Spinal Stenosis
• Intervertebral discs that frequently herniate

How is LLIF or lateral lumbar interbody fusion done?

First, an incision is made on the patient’s side and a path is made to the spine. Specialized monitors are used during this process to ensure that the nerves are not harmed. Dr. Pennicooke will then insert a tubal dilator, which acts like a large straw that surgical instruments can be passed through to access the spinal column without interacting with other organs in the spine. The injured intervertebral disc is then removed, and the space is filled with bone tissue from a bone graft. Surgical screws are then used to hold the vertebrae in place, to allow the bone tissue to heal and allow the two spinal bones (vertebrae) to join together. Then, after ensuring proper placement, Dr. Pennicooke will remove all surgical tools and close the incision.

How long does it take to recover from lateral lumbar interbody fusion (LLIF) surgery?

Lateral lumbar interbody fusion surgery typically requires at least 1 night in the hospital. Typically, Dr. Pennicooke performs a LLIF as a first stage of a two stage operation, and performs the second stage the same day or the next day. Most patients will be encouraged to walk immediately following the surgery, with specific movement restrictions such as no bending, twisting, or lifting of any objects. Patients are typically allowed to return to work after approximately 2 to 3 weeks depending on their function and pain level. Patient also typically return to full normal activities in approximately 2 to 3 months. Dr. Pennicooke will provide each patient with a more specific recovery timeline, tailored to their surgery and medical status.

Does LLIF work? What is the success rate of a lateral lumbar interbody fusion?

Lateral lumbar interbody fusion, when safe to be performed, is effective in reducing pain, with a lower  risk of infection and quicker recovery time as compared to other approaches to spinal fusion.