Albrecht Carolin, Schwendner Maximilian, Backhaus Paul, Butenschoen Vicki M, Meyer Bernhard
Department of Neurosurgery, Technical University of Munich, TUM School of Medicine and Health, Klinikum Rechts der Isar, Germany.
Department of Neurosurgery, Heidelberg University Hospital, Germany.
Brain Spine. 2025 Jul 5;5:104321. doi: 10.1016/j.bas.2025.104321. eCollection 2025.
Extreme lateral interbody fusion (XLIF) is commonly used for scoliosis and spondylolisthesis in conjunction with posterior spinal fixation. Stand-alone XLIF may serve as an intermediate strategy for radicular symptoms in neuroforaminal or spinal canal stenosis with severe coronal imbalance, avoiding extensive posterior fixation in frail patients. This study evaluated its efficacy in treating radicular symptoms in degenerative scoliotic patients without posterior instrumentation.
We retrospectively analyzed 19 patients who underwent stand-alone XLIF and dorsal decompression if required between January 2021-June 2024 for degenerative stenosis due to thoracolumbar scoliosis or listhesis with coronal deformity. Outcomes included symptom relief, revision surgery and radiological features like foraminal height restoration. We correlated initial diagnosis and fused levels with success rates to identify predictive factors.
Patients ranged from 65 to 86 years, 47 % were male and 53 % female. Most (42.1 %) underwent single-level fusion; 31.6 % had up to three levels fused. Radicular symptom relief was achieved in 52.6 % of patients following stand-alone XLIF. An additional 36.8 % experienced symptom relief after secondary dorsal decompression resulting in an overall relief rate of 89.5 %. Two patients (10.5 %) required secondary posterior instrumentation. Complications included retroperitoneal hematoma and cage dislocation.
After stand-alone XLIF, 89.5 % of patients achieved pain relief. This procedure addresses neuroforaminal stenosis via indirect decompression and supports secondary fusion, reducing the need for extensive corrective spondylodesis. It is a viable option for frail patients with degenerative scoliosis and radicular symptoms. However, no long-term follow-up was performed and conclusions regarding durability are limited.
极外侧椎间融合术（XLIF）通常与后路脊柱固定术联合用于治疗脊柱侧弯和腰椎滑脱。单纯的XLIF可作为治疗神经孔或椎管狭窄伴严重冠状面失衡引起的神经根症状的一种中间策略，避免对体弱患者进行广泛的后路固定。本研究评估了其在治疗无后路内固定的退行性脊柱侧凸患者神经根症状方面的疗效。
我们回顾性分析了2021年1月至2024年6月期间因胸腰椎脊柱侧弯或伴有冠状畸形的腰椎滑脱导致退行性狭窄而接受单纯XLIF及必要时进行后路减压的19例患者。结果包括症状缓解情况、翻修手术以及椎间孔高度恢复等影像学特征。我们将初始诊断和融合节段与成功率进行关联，以确定预测因素。
患者年龄在65至86岁之间，男性占47%，女性占53%。大多数（42.1%）患者接受了单节段融合；31.6%的患者融合节段多达三个。单纯XLIF术后52.6%的患者神经根症状得到缓解。另外36.8%的患者在二次后路减压后症状缓解，总体缓解率为89.5%。两名患者（10.5%）需要二次后路内固定。并发症包括腹膜后血肿和椎间融合器移位。
单纯XLIF术后，89.5%的患者疼痛得到缓解。该手术通过间接减压解决神经孔狭窄问题，并支持二次融合，减少了广泛的矫正性脊柱融合术的需求。对于患有退行性脊柱侧弯和神经根症状的体弱患者来说，这是一个可行的选择。然而，未进行长期随访，关于耐久性的结论有限。
