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This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
The lateral transpsoas approach for anterior lumbar interbody fusion (extreme lateral interbody fusion (XLIF)) was developed as a less-invasive alternative to conventional anterior and posterior approaches for interbody fusion [1]. Similar to anterior exposures for lumbar interbody fusion, the lateral approach allows for placement of a wide footprint intervertebral cage with wide apertures to provide superior anterior column realignment [2, 3] as well as a healthy fusion environment [4], without anterior and posterior longitudinal ligament (ALL and PLL) resection. In addition, the lateral approach mitigates many of the risks more common to traditional approaches, namely, vascular and visceral risks associated with anterior approaches [5–8] and the neural complications and bony resection common to posterior approaches [9, 10]. However, safe passage through the psoas muscle requires neuromonitoring to identify the nerves of the lumbar plexus, the injury of which represents a significant risk of the approach.
Since the introduction of the approach in the literature in 2006 [1], the procedure has increased in popularity, and reports of safety and outcome continue to be needed to fully validate the approach, especially during early cases of a new approach where a learning curve may be present [11, 12]. The purpose of this study was to examine clinical and radiographic outcomes in the first thirty patients treated with the XLIF approach by one surgeon in Melbourne, Australia.
2. Materials and Methods
Data were collected through a prospective registry, with retrospective analysis performed of the first 30 (consecutive) patients treated with extreme lateral interbody fusion (XLIF, NuVasive Inc., San Diego, CA, USA) by a single surgeon (GM) in Melbourne, Australia from February 2011 to October 2011. Patients were treated only after failure of extended conservative therapy and imaging studies, including dynamic (flexion, extension, and lateral bending) radiography, computed tomography (CT) coregistered with bone scans, magnetic resonance imaging (MRI), and bone mineral density (DEXA) scans, as appropriate. Data were collected preoperatively and then postoperatively at standard follow-up intervals for one year postoperatively.
Baseline patient information included basic demographic information as well as the primary indication for surgery and baseline...