Degenerative deformities of the lumbar spine. Treatment approach by minimal invasive anterior correction by extreme lateral interbody fusion. Technical and radiological aspects and review of the literature

There is a growing number of patients with spinal deformities related impairment of life quality. Progress in medicine offers surgical treatment of spinal deformities also in the elderly. However, traditional posterior instrumentation and fusion is still related with a high rate of complications. The extreme lateral interbody fusion procedure (XLIF) seems promising in treating degenerative deformities more efficient with less surgical trauma. Our own clinical data based on 41 patients treated on 70 levels reveal the open minimal dissection of the psoas muscle to be a safe alternative in comparison to the intraoperative neurmonitoring. No nerve damage was observed. The review of the literature shows in a high percentage of patients with transitory weakness for hip flexion and sensory disturbance at the anterior thigh. More often than reported in the literature we encountered vertebral body fractures with subsidence of the cage. Nevertheless, the potential for deformity correction is high with a minimal effort.