Extreme Lateral Interbody Fusion: An Observational Study of Functional and Radiological Outcome

Abstract

Introduction: Extreme lateral interbody fusion (XLIF) constitutes a minimally invasive procedure employed to address a spectrum of conditions including degenerative disc disorders, trauma, infections, and deformities. Despite its potential, there exists a scarcity of studies exploring perioperative functional and radiological outcomes. This prospective observational study seeks to address this gap by reporting these outcomes in patients treated at the King Faisal Specialist Hospital & Research Centre (KFSHRC) over a mean follow-up period of 5 years.
 Methods This case series amassed baseline patient data, encompassing gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) classification, operated level, and posterior fixation type. Primary outcome measures encompassed the Oswestry Disability Index (ODI), Roland-Morris Disability Index (RMDI), Euro-Qol (EQ)-5D, visual analog scale (VAS), and EQ-5D index scores. Additionally, the study delved into secondary outcomes encompassing radiological parameters such as sagittal balance, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence.
 Results: The study embraced 51 patients, comprising 9 females and 42 males, with a mean age of 58.6 years and a mean BMI of 29.3. The patients were followed for an average of 5.2 years. Stratification according to ASA classification revealed that 11.8% of patients were classified as ASA I, 52.9% as ASA II, and 35.3% as ASA III. The levels of operation included 60.8% at L4-L5, 33.3% at L3-L4, and 5.9% at L2-L3. The fixation techniques employed encompassed 58.8% bilateral and 41.2% unilateral approaches. The analysis of the primary clinical outcomes unveiled statistically significant enhancements in ODI, RMDI, EQ-5D VAS, and EQ-5D index scores. While lumbar lordosis registered a significant decrease, radiological parameters indicated non-significant shifts in pelvic incidence, pelvic tilt, and sacral slope.
 Conclusion The XLIF procedure emerges as an efficacious and minimally invasive avenue for managing degenerative disc disorders. The reported functional and radiological outcomes prove satisfactory. However, while demonstrably effective, the generation of clinical recommendations necessitates the compilation of results from randomized clinical trials.