Minimally Invasive Surgery
MIS: Extreme Lateral Interbody Fusion (XLIF)
A Minimally Invasive Approach to Lumbar Fusion
Extreme Lateral Interbody Fusion (XLIF) is a type of spinal fusion performed through the patient’s side (lateral approach). Instead of making a large incision in the back, the surgeon accesses the spine through a small incision in the flank, gently moving aside muscles to reach the vertebrae and discs. At Desert Spine and Pain, we use XLIF to stabilize the spine and relieve pressure on nerves when conservative treatments have not been effective. Under the expertise of Dr. David L. Greenwald, M.D., FAANS, FACS, one of the nation’s top neurosurgeons, this approach often allows patients to experience faster recovery, less pain, and smaller incisions compared to traditional fusion.
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What Is XLIF?
In simple terms: XLIF fuses two vertebrae together by removing a damaged disc and placing a spacer (cage) filled with bone graft through a side incision.
Scientifically: The lateral transpsoas approach provides direct access to the intervertebral disc space without disrupting posterior spinal muscles. A cage packed with autograft/allograft is inserted to restore disc height and promote arthrodesis (fusion).
Conditions Treated with XLIF
Degenerative Disc Disease with collapse or instability
Spondylolisthesis (low to moderate grade)
Spinal Stenosis with instability
Recurrent disc herniation requiring stabilization
Post-traumatic degeneration or deformity correction
Benefits of XLIF
Smaller incision compared to open back fusion
Less muscle disruption (posterior muscles are spared)
Shorter hospital stay (often 1–2 days)
Faster recovery and return to activity
Excellent restoration of disc height and indirect decompression of nerves
Lower blood loss than traditional posterior approaches
The XLIF Procedure: Step by Step
Anesthesia & positioning – General anesthesia; patient positioned on their side.
Small flank incision – A 1–2 inch incision is made in the patient’s side.
Navigating through muscles – Tubular retractors gently spread the psoas muscle to access the disc space.
Disc removal – The damaged disc is removed.
Implant placement – A cage (spacer) filled with bone graft is inserted to restore disc height and promote fusion.
Stabilization – Screws, rods, or plates may be added through minimally invasive posterior incisions if needed.
Closure & recovery – Incision is closed; patients often walk the same day.
Risks and Limitations
Nerve irritation in the psoas muscle (temporary thigh numbness/weakness possible)
General surgical risks: infection, bleeding, hardware issues, non-union
Not ideal for all levels of the spine (best for lumbar levels L1–L5)
Rare complications include vascular or bowel injury
Recovery Timeline
Day 0–1: Walking the same day or next morning
Weeks 2–6: Light activities; many patients return to desk work
Weeks 6–12: Fusion begins consolidating; activity increases with PT guidance
3–6 months: Progressive return to normal life; fusion solidifying
6–12 months: Complete bony fusion expected in most patients
Why Choose Desert Spine and Pain?
Expert neurosurgeon – Dr. Greenwald is skilled in advanced MIS fusion approaches, including XLIF
Patient-focused care – Thorough evaluation to determine if XLIF is the right option
Smaller incisions, faster recovery – Minimally invasive techniques designed to reduce fear and downtime
Comprehensive treatment – We combine MIS with PT, injections, and conservative care whenever possible
Frequently Asked Questions
How is XLIF different from traditional fusion?
XLIF uses a side approach instead of the back, sparing muscles and often allowing faster recovery.
Will I need rods and screws with XLIF?
Often yes. Posterior fixation adds stability and increases fusion success.
Is XLIF painful?
All surgery involves some discomfort, but XLIF typically causes less pain than open fusion.
How soon can I return to work?
Desk workers may return within 2–4 weeks; physical jobs may take 2–3 months.
How does Desert Spine and Pain perform XLIF differently?
We combine neurosurgical precision, navigation technology, and minimally invasive techniques under Dr. Greenwald’s expertise.
Dr. David L. Greenwald, MD
Neuro-Spine Surgeon
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If you’re suffering from chronic back or leg pain and want to explore advanced surgical options like Extreme Lateral Interbody Fusion (XLIF), Dr. Greenwald and his dedicated team are here to help. We’ll thoroughly evaluate your spine condition, discuss whether XLIF is right for you, and guide you through every step of the treatment process. Every step you take toward recovery brings you closer to restored mobility and lasting relief. Schedule your consultation today and learn how Dr. Greenwald’s expertise in minimally invasive spine surgery can help you reclaim your quality of life.
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Over 30 Years Experience in Orthopedic & Neuro Spine Surgeries.
Dr. David L. Greenwald, M.D., F.A.C.S.
Neurosurgeon | Spine Surgeon | Regenerative Medicine
Dr. David L. Greenwald, MD, FACS, is a board-certified spine surgeon with advanced expertise in Extreme Lateral Interbody Fusion (XLIF), a minimally invasive procedure designed to treat conditions such as degenerative disc disease, spondylolisthesis, and scoliosis. Unlike traditional back surgeries, XLIF is performed through the patient’s side, avoiding major back muscles and allowing for faster recovery, reduced pain, and minimal scarring. Dr. Greenwald utilizes state-of-the-art imaging and nerve monitoring to ensure precision and safety throughout the procedure. His extensive experience and patient-focused approach have helped individuals across South Florida regain stability, relieve chronic back or leg pain, and return to active, fulfilling lives with confidence.
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