During XLIF, surgeons work in areas that are close to nerves on the spinal column. To prevent nerve damage, nerve monitoring, called electromyography or EMG, is used that provides surgeons with real-time information about nerve position relative to his or her instruments.

XLIF is performed under general anaesthesia so you’ll be asleep during surgery. Steps of the surgery include:

• Once you are asleep, you will be positioned on your side. The surgeon will use X-ray to locate the disc to remove and will use a marker to mark your skin above the disc.
• A small incision is first made toward your back. The surgeon places his or her finger through this incision to protect the peritoneum (sac containing abdominal organs) as instruments pass through the lateral space to the spine.
• A second incision is made on your side through which the instruments will pass to remove the herniated disc.
• Special instruments, called tubular dilators, will be inserted through the muscle on the side of the vertebrae. X-rays and nerve monitoring will safely guide instruments to the appropriate location and away from nerves.
• After tubular dilators are placed, a tissue retractor is placed over them, locked to the surgical table and held open to stretch the small incisions and provide light and instrument access to the disc space.
• With the spinal disc visible, the disc is removed.
• An implant is placed into the empty disc space. The implant is filled with bone graft for fusion.
• An X-ray image ensures the implant is correctly placed. The retractor is removed and the small incisions are closed with a few stitches and a bandage.

Depending on a patient’s condition, additional support, such as screws, plates or rods, may be inserted to stabilize the spine for fusion.