Ansari Yusuf-Zain, Jader Arwa, Kidwai Abdul Hameed, Halalmeh Dia R
Department of Biology, Temple University, 1801 N Broad St, Philadelphia, PA, 19122, USA.
Department of Neurosurgery, University of Kufa, Kufa, Iraq.
Acta Neurochir (Wien). 2025 Aug 13;167(1):221. doi: 10.1007/s00701-025-06643-z.
This review examines the novel application of the Extreme Lateral Interbody Fusion (XLIF) approach for the removal of foreign bodies in the spine, including subsided cages, failed hardware, and other implants. It aims to evaluate the efficacy, safety, and technical considerations of XLIF in this context and compare it to traditional anterior and posterior surgical approaches.
A comprehensive literature search in accordance with PRISMA was conducted using Google Scholar, PubMed/MEDLINE, and the Cochrane Library. Search terms included "extreme lateral interbody fusion," "lateral lumbar interbody fusion," "cage retrieval," "revision surgery," and "foreign body removal." Articles were selected based on relevance to XLIF use in foreign body removal and included case reports, clinical trials, and observational studies published in English before April 7, 2025.
Seven documented cases met inclusion criteria. The XLIF approach demonstrated advantages such as reduced operative time, blood loss, and shorter hospital stays. It allowed safe access around scar tissue and critical neurovascular structures. The technique was successfully used to remove migrated or failed implants in the lumbar spine with minimal complications, most of which were transient. The approach also enabled the insertion of larger interbody cages, contributing to improved spinal stability and fusion outcomes.
The XLIF approach is a promising alternative for foreign body removal in complex spinal revision surgeries. However, potential complications, such as transient nerve injury, underscore the need for careful patient selection and surgical expertise. Further studies are needed to validate its broader clinical application.
本综述探讨了极外侧椎间融合术（XLIF）在脊柱异物取出中的新应用，包括下沉的椎间融合器、失败的内固定器械及其他植入物。其目的是评估XLIF在此情况下的疗效、安全性和技术要点，并与传统的前路和后路手术方法进行比较。
按照PRISMA标准，通过谷歌学术、PubMed/MEDLINE和Cochrane图书馆进行了全面的文献检索。检索词包括“极外侧椎间融合术”“外侧腰椎椎间融合术”“椎间融合器取出”“翻修手术”和“异物取出”。根据与XLIF在异物取出中的应用相关性选择文章，包括2025年4月7日前发表的英文病例报告、临床试验和观察性研究。
七例记录在案的病例符合纳入标准。XLIF方法显示出优势，如手术时间缩短、出血量减少和住院时间缩短。它能安全地进入瘢痕组织和关键神经血管结构周围。该技术成功用于取出腰椎中移位或失败的植入物，并发症极少，且大多为短暂性。该方法还能插入更大的椎间融合器，有助于改善脊柱稳定性和融合效果。
XLIF方法在复杂脊柱翻修手术的异物取出方面是一种有前景的替代方法。然而，诸如短暂性神经损伤等潜在并发症强调了仔细选择患者和具备手术专业知识的必要性。需要进一步研究以验证其更广泛的临床应用。
