What XLIF Is (two ways to understand it)

• In simple terms: We make a small incision on your side, gently pass between muscles to the disc, remove the worn disc, and place a spacer (cage) filled with bone graft to restore height and fuse the bones together. This opens space for nerves and stabilizes the segment.
  
  

• Scientifically: Via a lateral transpsoas corridor, sequential dilation and a tubular retractor create a working channel to the disc. After complete discectomy, careful endplate preparation and insertion of a lordotic interbody cage packed with autograft/allograft restore disc height, enable indirect decompression of the foramina, and promote interbody arthrodesis. Supplemental percutaneous pedicle screw fixation is added when indicated.
  
  

When We Recommend XLIF

• Symptomatic degenerative disc disease with collapse and instability
  
  

• Spondylolisthesis (low–moderate grades) with nerve compression
  
  

• Recurrent disc herniation needing stabilization (after failed discectomy)
  
  

• Selected spinal stenosis with loss of disc height
  
  

XLIF is typically used for L1–L5. At L4–5, we plan carefully because the lumbar plexus sits more anteriorly in the psoas there. L5–S1 is usually not reachable laterally (iliac crest/vascular anatomy).

Who Is Not a Candidate (generally)

• Need for direct decompression of severe central stenosis without adequate indirect decompression
  
  

• Prior retroperitoneal scarring or unfavorable vascular/neurologic anatomy
  
  

• Active infection, tumor needing a different approach, or severe osteoporosis without optimization
  
  

• Levels where the iliac crest or rib obstructs a safe corridor
  
  

Pre-Op Planning (how we make it safe)

• Imaging: Standing X-rays, MRI, and often CT to map bony anatomy/endplates.
  
  

• Neuromonitoring plan: Real-time EMG/MEPs/SSEPs for psoas/lumbar plexus safety.
  
  

• Medical optimization: Smoking cessation, diabetes control, bone density support; medication timing (e.g., anticoagulants/NSAIDs).
  
  

• Prehab: Targeted physical therapy to improve core strength and gait prior to surgery.
  
  

The XLIF Procedure: Full Walkthrough

Plain-English overview (what you’ll experience)

1. Anesthesia & positioning: You’re asleep (general anesthesia). You’ll lie on your side on a special table that lets us confirm the level with live X-ray.
   
   

2. Small side incision: We make a 1–2 inch incision over the target disc; a second tiny incision may be used for guidance instruments.
   
   

3. Muscle-sparing path: We gently separate (don’t cut) muscles of the flank and pass through the psoas muscle with real-time nerve monitoring.
   
   

4. Disc work: We remove the bad disc and clean the bony surfaces so they’ll grow together.
   
   

5. Spacer (cage) placement: We insert a cage filled with bone graft. This restores height, opens nerve channels, and creates a stable bridge for bone to fuse.
   
   

6. Stabilization (if needed): Through two tiny back incisions, we place percutaneous pedicle screws/rods for extra stability.
   
   

7. Close & recover: Most patients stand and walk the same day; many go home next day.
   
   

Surgeon-level detail (how it’s actually done)

• Positioning: True lateral decubitus; table “break” may assist lordosis. AP/lateral fluoroscopy confirms level and perfect trajectory.
  
  

• Retroperitoneal corridor: Blunt dissection to retroperitoneal space; psoas identified.
  
  

• Neuromonitoring-guided transpsoas dilation: Sequential dilators advance with triggered EMG and, when used, MEP/SSEP feedback to avoid the lumbar plexus.
  
  

• Tubular retractor fixation: Docked on the disc; intraoperative fluoroscopy confirms orthogonal alignment to disc plane.
  
  

• Discectomy & endplate prep: Annulotomy; complete disc removal; shavers, curettes, rasps prepare endplates—preserve cortical endplate to reduce subsidence risk.
  
  

• Trialing & cage selection: Choose footprint and lordosis angle to restore sagittal alignment; pack cage with autograft, allograft, or cellular allograft as indicated.
  
  

• Cage insertion: Fluoro-guided; confirm position on AP/lateral; check for indirect decompression (foraminal height).
  
  

• Supplemental fixation: Percutaneous pedicle screws (often bilateral) and rods via separate tiny posterior incisions, if needed for stability/grade of slip/quality of bone.
  
  

• Hemostasis/closure: Irrigation; layered closure. Drains rarely required in pure MIS lateral cases.
  
  

Implants, Grafts, and Biologics (what we use & why)

• Interbody cages: PEEK, titanium, or titanium-coated PEEK; large lateral footprint supports load and reduces subsidence risk.
  
  

• Grafts: Local autograft, iliac crest autograft (select cases), structural allograft, demineralized bone matrix; bone growth stimulators may be used post-op in smokers/osteopenia.
  
  

• Fixation: Percutaneous pedicle screw systems for immediate stability, especially in spondylolisthesis/instability.
  
  

Benefits of XLIF

• Smaller incisions and less muscle disruption than traditional posterior fusion
  
  

• Lower blood loss, shorter stays (often 1–2 days)
  
  

• Indirect decompression: Restoring disc height enlarges foramina for nerve roots
  
  

• Faster recovery for many patients with fewer activity restrictions early on
  
  

Risks & How We Reduce Them

• Transient thigh numbness/hip flexor weakness (psoas/plexus retraction) — minimized by rigorous neuromonitoring and limited retraction time
  
  

• Infection, bleeding, DVT/PE, hardware issues, non-union — mitigated by sterile technique, antibiotics, early walking, and strict fusion protocols
  
  

• Rare injuries (segmental vessels/bowel/ureter) — avoided with imaging, anatomy planning, and experienced technique
  
  

Recovery & Restrictions (typical pattern)

• Hospital: Same day or overnight; out of bed within hours
  
  

• 0–2 weeks: Walk frequently; no bending, lifting, twisting; short showers after 48–72 hrs if incision is dry; light home activity
  
  

• 2–6 weeks: Many return to desk work; start gentle core PT if ordered
  
  

• 6–12 weeks: Activity builds; light cardio, progressive PT; imaging to confirm healing
  
  

• 3–6 months: Most everyday activities resume; add strength work as guided
  
  

• 6–12+ months: Fusion consolidation; advanced lifting/sport cleared as bone matures
  
  

Bracing: Sometimes used short-term—see Bracing.
Pain plan: Multimodal meds; we aim for minimal opioids and early mobility.
Smoking: Must stop—nicotine impairs fusion.

How to Prepare

• Arrange a helper at home for the first week
  
  

• Stop nicotine; follow medication timing (blood thinners/NSAIDs)
  
  

• Set up a “recovery zone” (firm chair, grabber, shower seat if needed)
  
  

• Pre-op antibacterial wash; fasting instructions from anesthesia
  
  

• Bring imaging and your medication list on surgery day
  
  

Why Desert Spine and Pain

• Neurosurgeon-led, MIS-focused team with deep XLIF expertise
  
  

• Conservative-first, then precise surgery when it’s clearly beneficial
  
  

• Clear timelines, proactive communication, and coordinated Physical Therapy
  
  

Frequently Asked Questions

How is XLIF different from TLIF/PLIF?

XLIF approaches from the side, sparing back muscles and often allowing quicker recovery. TLIF/PLIF are posterior approaches through the back that may be better for certain anatomies or when direct decompression is essential.

Will I need screws and rods?

Often yes—percutaneous pedicle screws add stability and improve fusion success, especially with spondylolisthesis or poor bone quality.

How soon can I drive or work?

When you’re off narcotics and can safely react (often 1–2 weeks for desk work; longer for manual labor). We tailor this together.

Do I need a brace?

Sometimes, short-term. We aim to wean quickly as PT builds strength.

What if I have thigh numbness after surgery?

It usually improves over weeks as the psoas settles. We minimize this risk with neuromonitoring and gentle, time-limited retraction.