title: Clinical outcome and fusion rates after the first 30 extreme lateral interbody fusions.
abstract: BACKGROUND
  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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Neuroscience Institute, Epworth Hospital, Bridge Road, Melbourne, VIC 3121, Australia. gmalham@bigpond.net.au
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Malham
authors.forename: Ngaire J
authors.initials: NJ
authors.lastname: Ellis
authors.forename: Rhiannon M
authors.initials: RM
authors.lastname: Parker
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Seex
mesh_terms: D000203:Activities of Daily Living; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology* / Q000517:prevention & control*; D010147:Pain Measurement; D020127:Recovery of Function; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome