4. XLIF Surgical TechniqueExtreme lateral interbody fusion, or XLIF, is a 90�� off midline or true lateral approach that allows for large graft placement and excellent disk height restoration and provides indirect decompression at the stenotic motion segment. This approach can be performed selleck chemicals llc using two 3cm to 4cm skin incisions. Safe passage to the retroperitoneal space is assured by gentle blunt dissection. As the psoas muscle is traversed, the lumbosacral plexus is protected by the use of automated electrophysiology. Exposure is achieved with an expandable three-bladed retractor, which allows for direct illuminated visualization facilitating diskectomy and complete anterior column stabilization using a large load-bearing implant.

In patients with significant listhetic deformity, the adherence to procedural technique, including careful patient positioning, gentle retroperitoneal dissection, and meticulous psoas traverse using advanced neurological monitoring before performing a complete discectomy and placing a properly size interbody spacer is essential [13] where neural structures are pulled ventrally by the slipping L4 vertebral body (Figure 2).Figure 2MRI scan showing spinal stenosis and spondylolisthesis.It is impossible to overemphasize the importance of reliable, timely monitoring of the neural elements as the surgeon traverses the psoas muscle. Visual identification of the lumbar plexus is not possible but the plexus can be protected by using an automated real-time electrophysiology technology (Figure 3).Figure 3Lateral fluorogram showing dorsal retractor placement.

3. ResultsThe demographic, diagnosis, and comorbidity data for the total cohort are summarized in Table 1. For all patients, hospital stay averaged 1.2 days and hemoglobin decreased 1.4g on average. There were two (3.4%) complications in the total cohort, one patient experiencing postoperative ileus, the second having a broken pedicle screw on radiographs obtained after a motor vehicle accident 14 months after surgery. CT imaging showed a solid fusion and the patient was asymptomatic. There were no infections. Although early postoperative transient upper thigh pain and hip flexion weakness were common, as expected consequences to operative trauma to the psoas muscle, these symptoms were not persistent. There were no neurologic deficits. Two (3.4%) patients of the total cohort underwent Cilengitide further surgery within one year: both for adjacent segment disease, one treated with PLF, the other with XLIF.Table 1Patient demographics of grade II spondylolisthesis patients treated with extreme lateral interbody fusion (XLIF).