Abstract

Introduction: Minimally disruptive approaches to the anterior lumbar spine continue to evolve in a quest to reduce approach-related morbidity. We report a series of three patients who underwent a lateral retroperitoneal, trans-psoas approach via the XLIF to the interbody disc space allowing for complete discectomy, distraction, and interbody fusion without the need for an approach surgeon. Methods: We evaluate the results of anterior lumbar fusions in 3 patients that underwent surgery from an extreme lateral approach (XLIF) for adult degenerative scoliosis. The first was a 68-year-old man with degenerative disc disease and significant loss of disc height at the L3-4 level who underwent an L3-4 XLIF. The second was a 58-year-old woman with degenerative disc disease at L2-3 who underwent an L2-3 XLIF. The third, a 63-year-old woman with degenerative disc disease at L2-3 with a significant loss of disc height who underwent a 3-level XLIF (L2-3, L3-4, L4-5) followed by a staggered minimally-invasive percutaneous pedicle screw instrumentation. Results: Postoperatively, all patients did well, showed significant improvement in presenting symptoms, and left the hospital on postoperative day 3 with no complications. The postoperative images demonstrated significant deformity correction in comparison to preoperative imaging. Most importantly, patients' symptoms resolved, recovery period was shortened, and they were exposed to less potential risks and morbidity in comparison to traditional surgical interventions. Conclusion: The XLIF procedure allows for anterior access to the lower lumbar disc space for interbody distraction and fusion, via a minimally-invasive corridor without an approach surgeon or the potential complications of an anterior approach.