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YB1125
02-17-2012, 04:50 PM
My Doctor wants to perform Minimally invasive Surgery using the Xlif Technique for my Lumbar scoliosis 45 degrees L1-L4. He said I am young and healthy and most likely a good outcome.
I know it is still new technique and maybe many of you did not hear about it yet, but anyone that does have experience.. I would love to hear, anything would help, any link, thoughts.. etc

Also, Any case studies out there comparing minimally invasive approach to the traditional open back approach?

Here is the link that describes the technique http://www.youtube.com/watch?v=Z5nkVaduSSg

jrnyc
02-17-2012, 06:57 PM
Dr Anand in LA is a big proponent of minimally invasive surgery for lumbar....
the procedure is not new for thoracic, but is newer for lumbar....
you can check out Dr Anand's website...he has a video of the procedure...without any blood or gore...
minimally invasive has been discussed on this forum before...
if you do a search, you will find the topic discussed on this forum...
there are several surgeons who use the procedure by now...

jess

leahdragonfly
02-17-2012, 09:34 PM
Hi there,

I just had XLIF's done at L2/3 and L3/4 along with a posterior revision for broken rods, so I can tell you all you want to know about what an XLIF is like.

However, first I am wondering if your doctor is proposing XLIF's alone, is he saying it will give any correction of your curve, or just fuse it in place? My understanding is that it would not be able to correct a curve at all as a stand-alone procedure. That would be important to know.

Let me know what other questions you have and I will gladly answer them.

jrnyc
02-17-2012, 10:45 PM
there are different minimally invasive approaches...PLIF, AXILF, etc...
the minimal approach can be from the back, side, etc..
all you have to do is google it...
or any of the surgeons who use it....
Dr Lonner offered me "partial" minially invasive...and i need rods, plus discs repaired...

jess

LindaRacine
02-17-2012, 10:49 PM
Gayle...

We've seen a lot of patients whose curve gets significantly better with just the XLIF, although it is usually followed by a PSF. I think there may be some surgeons doing standalone XLIFs.

--Lind

jrnyc
02-18-2012, 01:44 AM
how can that be enough for patients with large curves....?

jess

LindaRacine
02-18-2012, 12:08 PM
how can that be enough for patients with large curves....?

jess

Well, no one said it was possible for "large" curves. :)

If you look at Dr. Deviren's presentation from our Scoliosis Multidisciplinary conference last December:

http://orthosurg.ucsf.edu/sites/default/files//pdf/spine%20presentations/8-Surgery_Deviren.pdf

Check out page 32 (titled eXtreme Lateral Interbody Fusion (XLIF). The X-ray on the left is prep, and the X-ray on the right is after XLIFs.

On page 45 of that presentation, you can see that the XLIF gave the patient a huge correction in the fractional curve at the very bottom of the spine.

titaniumed
02-18-2012, 02:09 PM
Hard to believe that the perfect correction on the right x-ray is before hardware...this person had quite the release with her anterior. (xlif)

Of course, next comes the hardware.
Ed

YB1125
02-19-2012, 05:48 AM
Jess- Thank you, I have looked into Dr Anand before and spoke to his assistant, unfortunately he does not take my health Insurance.

leahdragonfly-

I just had XLIF's done at L2/3 and L3/4 along with a posterior revision for broken rods, so I can tell you all you want to know about what an XLIF is like.

However, first I am wondering if your doctor is proposing XLIF's alone, is he saying it will give any correction of your curve, or just fuse it in place? My understanding is that it would not be able to correct a curve at all as a stand-alone procedure. That would be important to know.

Let me know what other questions you have and I will gladly answer them.
The Xlif was proposing also 2 shorter rods and 4 screws. Do you not have rods in your back?
and thank you, please tell me all about it.. Is the recovery really that fast? Do you have flexibility with your spine? any pain afterwards? ..etc

YB1125
02-19-2012, 01:59 PM
LindaRacine-
Did you mean Xlif without rods? .. or just the material they put between the vertebrates to make it straight? Does it perform without rods?
Also when I clicked the link I could not find any info about eXtreme Lateral Interbody Fusion by Dr. Deviren.

LindaRacine
02-19-2012, 02:59 PM
LindaRacine-
Did you mean Xlif without rods? .. or just the material they put between the vertebrates to make it straight? Does it perform without rods?
Also when I clicked the link I could not find any info about eXtreme Lateral Interbody Fusion by Dr. Deviren.

Not sure why you can't see the images I mentioned above. I'm able to click on the link, which opens the PDF. Then, I scroll down to the 32nd slide. The X-ray on the left is pre-op, and the x-ray on the right is post-op. You'll see that the patient had a lot of correction without rods and screws.

jrnyc
02-19-2012, 04:12 PM
is that page 32 you are referring to?? or is there a slide number?
i see all of it...pretty large on my screen, actually...

are there requirements that rule people in or out of having this form
of scoli surgery? what is the largest size curve it can address...?

jess

LindaRacine
02-19-2012, 04:31 PM
is that page 32 you are referring to?? or is there a slide number?
i see all of it...pretty large on my screen, actually...

are there requirements that rule people in or out of having this form
of scoli surgery? what is the largest size curve it can address...?

jess

As far as I can tell, there are no slide numbers on the actual slides. But, if you look at the header information in Acrobat or Preview, you can see that there are 69 slides. The title of the slide is eXtreme Lateral Interbody Fusion (XLIF). Not sure why I'm not able to describe this so people can find it.

I don't know which patients might get away with only an XLIF, but I'm guessing it's pretty unusual. You might be able to get a lot more information here:

http://www.thebetterwayback.org/

jrnyc
02-19-2012, 04:48 PM
thanks Linda...for that link....
but when i looked for doctors affiliated with it, i found a lot of names i
never saw before...none i recognized when i searched for Manhattan...
i wonder what the "usual" well known surgeons think of it...
???

jess

LindaRacine
02-19-2012, 04:58 PM
thanks Linda...for that link....
but when i looked for doctors affiliated with it, i found a lot of names i
never saw before...none i recognized when i searched for Manhattan...
i wonder what the "usual" well known surgeons think of it...
???

jess

As well as being used in scoliosis surgeries, the XLIF is also used for non-deformity surgeries, so it's no surprise that you don't recognize most of the names. As has been said many times before, surgeons have their own preference for implants and approach. I haven't looked, but I'm guessing that only one of the UCSF surgeons is listed on BetterWayBack, but there are at least 2-3 other surgeons who use the XLIF, but have not become members of SOLAS (probably just due to lack of time).

YB1125
02-20-2012, 02:23 AM
LindaRacine- Ok thank you, I was able to open it, this is amazing.

I wonder too if it could be done without rods, shot my surgeon Doctor an email asking if it could be done without the rods, will see what he says.

leahdragonfly
02-20-2012, 10:38 AM
Hi YB,

I will try to answer your questions. Our situations are quite different because I had posterior fusion from T8-sacrum 15 months ago, so yes, I do have rods and screws in the back. Two of the lumber levels failed to fuse and so my rods broke in January. I had the XLIF's done along with a posterior revision to repair the broken rods and destabilize and fuse the area.

It sounds like your surgeon is proposing a very limited, 3 level fusion with XLIF then posterior rods and screws. I am sure you would notice losing some mobility, but not nearly so much as if you had a longer fusion such as what I had. I lost a lot of mobility, although it's not the end of the world. I can do most everything I could do before, just some things I have to do in different ways. An example of something difficult is it is now impossible to stoop and look or reach into a low cabinet. Instead I have to kneel on the floor.

Since my surgery was a revision, and some of the hardware was replaced, it is hard to compare my surgery to what you will experience. My pain was well-controlled after surgery. I am still taking a low dose of oxycodone 3 times a day for pain. I will probably quit that within a week and maybe switch to something milder. I still have a very sore muscle along the left groin/upper thigh area that feels like sort of a very sore cramp, which is the result of how they access the spine during the XLIF. My surgeon told me I might get a numb patch on my thigh, but fortunately I didn't. This groin pain will hopefully go away, and it is not debilitating.

My XLIF incision along my left side is about 3" long, and it is healing nicely. I am now 2 weeks post-op, and I still have a lot of abdominal soreness and some belly swelling. I was able to get up to a chair the day after surgery, and I currently take 3 walks a day outside for about 10 minutes. I am also able to move around the house freely but I can't do any housework or anything like that yet. I can fix simple meals for myself and my kids and take care of my pets. Other than that I am still limited in my activities. I watch a lot of TV right now. I am not up to driving or shopping or cleaning just yet.

I hope this answers some of your questions, and please ask anything else you would like to know.

Good luck,

YB1125
02-20-2012, 11:09 PM
Thank you leahdragonfly for all the info. 2 weeks post operation sounds like you are healing very well, this is so uplifting to hear. Do you feel big difference in the recovery you had 15 months ago from the traditional surgery and now with the Xlif? Since you had both you probably can give the best impression of the all deal.. please do. Will you recommend Xlif over traditional?

My Surgeon got back with me about my question if Xlif can be done without rods, he said: "U can do the xlif w/o the rod, and possibly instrument from the same side i put the Graft in. If it doesn't heal, you may need to put rods in."

Very interesting.. I am going to ask what he recommends to do if both ways are possible and how being without rods will affect the mobility in a positive way, if there is any difference..

Pooka1
02-21-2012, 06:42 AM
Thank you leahdragonfly for all the info. 2 weeks post operation sounds like you are healing very well, this is so uplifting to hear. Do you feel big difference in the recovery you had 15 months ago from the traditional surgery and now with the Xlif? Since you had both you probably can give the best impression of the all deal.. please do. Will you recommend Xlif over traditional?

My Surgeon got back with me about my question if Xlif can be done without rods, he said: "U can do the xlif w/o the rod, and possibly instrument from the same side i put the Graft in. If it doesn't heal, you may need to put rods in."

Very interesting.. I am going to ask what he recommends to do if both ways are possible and how being without rods will affect the mobility in a positive way, if there is any difference..

XLIF appears to involve fusion as far as I can tell. If so, whether or not you have rods also should have no bearing whatsoever on mobility. It would be the same in both cases if the same levels are fused. Linda?

leahdragonfly
02-21-2012, 09:55 AM
Sharon, you are correct that the XLIF involves fusions (that's what the "f" stands for), so I don't see how an XLIF would not result in some loss of mobility. YB's proposed levels are pretty limited though, so I think she will not notice such a large loss of mobility as one does with a long fusion.

YB, yes, this recovery is much easier than my original surgery, which was a posterior open fusion of 11 levels along with a TLIF at L4. IF the XLIF can address all your needs and your surgeon thinks it will work, it might be worth a try. I think if he recommends the posterior rods and screws I would go with that recommendation, rather than just having the XLIF's and waiting to see if it will heal correctly or not. Better to get it all done securely on the first try if possible, in my opinion.

I would strongly suggest a second opinion before moving ahead, from a spine surgeon that specializes in scoliosis. You want to know all the issues before you proceed. Some surgeons will propose smaller surgeries knowing full well the pt will be back in the OR in a few years for a fusion extension. I had a second opinion like that. It was a little hard to walk away from at first, it sounded so quick and easy compared to what my surgeon was proposing, but I knew that my surgeon was right and I did not wish to undergo additional surgeries at a later date. Unfortunately I ended up with broken rods and so now here I am, recovering from a second surgery.....oh well, what can you do!

LindaRacine
02-21-2012, 10:11 AM
Yes, fusion is fusion, and there should be no difference in flexibility. I'm going to try to find out how often someone with scoliosis might get away with only the XLIF. I think it's pretty rare.

--Linda

LindaRacine
02-23-2012, 12:07 PM
how can that be enough for patients with large curves....?

jess

I just talked to Dr. Deviren. He said that a very small subset of patients can get away without requiring PSF. They would be patients with relatively small curves, no osteoporosis, and hypertrophic facets.

Pooka1
02-23-2012, 12:29 PM
I just talked to Dr. Deviren. He said that a very small subset of patients can get away without requiring PSF. They would be patients with relatively small curves, no osteoporosis, and hypertrophic facets.

Yes but there is no differnce in mobility between XLIF alone versus XLIF+PSF and there presumably is a higher risk of pseudoarthrosis without PSF so I don't get why someone would even want to forego PSF with XLIF.

LindaRacine
02-23-2012, 01:27 PM
Yes but there is no differnce in mobility between XLIF alone versus XLIF+PSF and there presumably is a higher risk of pseudoarthrosis without PSF so I don't get why someone would even want to forego PSF with XLIF.

One would assume because it would be a lot less invasive. If there was a reasonable chance that I could get away with a minimally invasive approach only, and there was enough evidence that the approach worked, I might be tempted to give it a shot. One could always go in for a second stage PSF later.

titaniumed
02-23-2012, 01:53 PM
Funny how an “anterior release” aids in correction, but many have staged A/P’s and are pretty much mobile during that time between surgeries. I was out between my surgeries, so I don’t know what that feels like.

The anterior releases somewhat, but it seems that it is only a small amount or percentage. My lumbar correction with my anterior preceding was about 50%. Just because they enter the front side, and remove the disc doesn’t mean that mobility is completely released at the level. This would be a good question for a surgeon. How much of a release does one achieve with a preceding anterior?

Since this anterior “release” is a lower percentage, it seems that it should be fine with 3 levels and smaller curves.

The XLIF accesses the anterior or front part of the “vertebral body”. The advancements with minimally invasive procedures sure makes sense. My gall bladder removal was done that way, 4 portals and I didn’t even take any meds after....Hard to believe but true.

Ed

LindaRacine
02-29-2012, 02:20 PM
Funny how an “anterior release” aids in correction, but many have staged A/P’s and are pretty much mobile during that time between surgeries. I was out between my surgeries, so I don’t know what that feels like.

The anterior releases somewhat, but it seems that it is only a small amount or percentage. My lumbar correction with my anterior preceding was about 50%. Just because they enter the front side, and remove the disc doesn’t mean that mobility is completely released at the level. This would be a good question for a surgeon. How much of a release does one achieve with a preceding anterior?

Since this anterior “release” is a lower percentage, it seems that it should be fine with 3 levels and smaller curves.

The XLIF accesses the anterior or front part of the “vertebral body”. The advancements with minimally invasive procedures sure makes sense. My gall bladder removal was done that way, 4 portals and I didn’t even take any meds after....Hard to believe but true.

Ed

Hi Ed...

Anterior releases are actually different than interbody fusions. Anterior release specifies just the discectomy. Interbody fusion is both a discectomy and a fusion.

--Linda