COVER STORY

Spine surgery is traditionally performed using either a posterior or anterior approach to the spine. In either case, the surgery requires large incisions that cause significant disruption to the muscles, bones, and ligaments (posterior approach) or delicate manipulation of major organs and blood vessels (anterior approach). The resulting trauma is responsible for the postprocedural pain, extended recovery time, and difficulty in returning to normal activities that are common by-products of spine surgery.

To address these likely side effects, NuVasive (San Diego) has developed a new surgical technique named the extreme lateral interbody fusion (XLIF) procedure.

Unlike traditional back surgery, XLIF surgery accesses the spine through the patient's side, or laterally (at a 90° angle to the spine). This minimally invasive approach avoids disrupting major muscles, tissues, and organs. Additionally, the XLIF procedure uses incisions that are much smaller than those in traditional back surgeries. The surgeon accesses the spine through two 1-in. incisions instead of the 5-in. incisions typically needed for traditional open-back surgery, resulting in a lower average blood loss. Often lasting only 70–90 minutes, a typical XLIF procedure takes about half the time of a traditional approach.

"The safety profile of the XLIF procedure, as compared with traditional, more open approaches, is greatly improved," says Mark Peterson, MD, a fellowship-trained spine surgeon at Providence Medford Medical Center (Medford, OR). "This is due to the avoidance of major anatomical structures, drastically mitigating any potential adverse events that have occurred with other types of procedures."

By limiting tissue disruption and surgical trauma, XLIF is less painful and allows for shorter hospital stays and recovery time. Peterson says that his XLIF surgery patients normally spend only one night in the hospital instead of the five nights typical of traditional surgery patients. And XLIF patients are often walking within two days, with a typical four- to six-week recovery period rather than the six months of recovery following traditional surgery. Faster recovery time also translates into savings for hospitals. Providence Medford Medical Center recorded a 20% cost savings when using NuVasive's XLIF procedure compared with a traditional anterior approach.

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