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The Scientific World Journal
Volume 2012, Article ID 246989, 7 pages
Clinical Study

Clinical Outcome and Fusion Rates after the First 30 Extreme Lateral Interbody Fusions

1Neuroscience Institute, Epworth Hospital, Bridge Road, Melbourne, VIC 3121, Australia
2Greg Malham Neurosurgeon, Suite 2, Level 1, 517 St. Kilda Road, Melbourne, VIC 3004, Australia
3Department of Neurosurgery, Macquarie University, Sydney, NSW 2109, Australia

Received 2 August 2012; Accepted 23 September 2012

Academic Editors: L. Pimenta, W. D. Smith, and W. Taylor

Copyright © 2012 Gregory M. Malham et al. 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.


Introduction. The lateral transpsoas approach for lumbar interbody fusion (XLIF) is gaining popularity. Studies examining a surgeon's early experience are rare. We aim to report treatment, complication, clinical, and radiographic outcomes in an early series of patients. Methods. Prospective data from the first thirty patients treated with XLIF by a single surgeon was reviewed. Outcome measures included pain, disability, and quality of life assessment. Radiographic assessment of fusion was performed by computed tomography. Results. Average follow-up was 11.5 months, operative time was 60 minutes per level and blood loss was 50 mL. Complications were observed: clinical subsidence, cage breakage upon insertion, new postoperative motor deficit and bowel injury. Approach side-effects were radiographic subsidence and anterior thigh sensory changes. Two patients required reoperation; microforaminotomy and pedicle screw fixation respectively. VAS back and leg pain decreased 63% and 56%, respectively. ODI improved 41.2% with 51.3% and 8.1% improvements in PCS and MCS. Complete fusion (last follow-up) was observed in 85%. Conclusion. The XLIF approach provides superior treatment, clinical outcomes and fusion rates compared to conventional surgical approaches with lowered complication rates. Mentor supervision for early cases and strict adherence to the surgical technique including neuromonitoring is essential.