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ty, stenosis, scoliosis and other spinal disorders. While it has tradition-
ally been an inpatient undertaking, recent developments are making
outpatient fusion not only possible, but preferable. Here are 4 key fac-
tors driving that transition.
1. XLIF
For lumbar fusion, the development of a minimally invasive technique
through an alternative approach has enabled less traumatic access to
the anterior spine. Extreme lateral interbody fusion, also known as
XLIF, is exploding in popularity among spine specialists. With the
patient positioned on his side, we enter through a small incision in the
flank, between the lower rib margin and the iliac crest. By avoiding an
abdominal incision and by dilating, not dissecting, the muscles of the
back, we're able to reach the disc space, remove the damaged disc, and
insert the bone graft material and fixation device with minimal trauma.
We're guided throughout the procedure by fluoroscopic imaging to
visualize the spinal structure and neural monitoring to determine how
close our instruments are to spinal nerves. But advances in operating
microscopes' illumination and magnification really give us an aggressive
view, on a plane-by-plane and tissue-by-tissue level, of our impact on the
anatomy and the results we're likely to deliver. XLIF has a steep learning
curve, but surgeons who are motivated to learn the technique will see a
dual payoff of solid outcomes and patient satisfaction.
2. Can-do patients
Patient selection is key to safe, predictable and successful outpatient
spinal fusion. There is a significant subset of the population — the
young, healthy, motivated patients with limited co-morbidities who
are amenable to education on outcomes and recovery, and who want
to avoid the inpatient stays and associated risks of hospitals — who
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