{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T12:31:37Z","timestamp":1762432297166,"version":"3.41.2"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,27]],"date-time":"2022-09-27T00:00:00Z","timestamp":1664236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Study Design<\/jats:title><jats:p>Technical report.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>Evaluate technical feasibility of extreme lateral interbody fusion (XLIF) at the L5-S1 level and provide an elaborate description of the surgical technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Summary of Background Data<\/jats:title><jats:p>With the development of surgical techniques, the indications for oblique lumbar interbody fusion (OLIF) surgery have been broadened to the L5\/S1 segment. However, this technique also has limitations. Different from OLIF, the L5\/S1 segment used to be considered the main contraindication for XLIF. To date, no authors have reported the application of XLIF at the L5\/S1 level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Only patients whose preoperative lumbar MRI showed the position of the psoas major muscles and blood vessels at the L5\/S1 level were similar to those seen at supra-L5 levels were seleted. By folding the operating table, the iliac crest was moved downward to expose the L5\/S1 intervertebral space during the operation. The remaining surgical procedures were consistent with routine XLIF surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>8 patients successfully underwent XLIF at the L5\/S1 level. The L5\/S1 disk spaces were always exposed sufficiently for disk preparation and cage insertion. The post operative radiographs showed a satisfactory L5\/S1 reconstruction with good cage position. Only 1 patient (12.5%) felt thigh numbness, and the symptoms gradually resolved after surgery and were no longer present in a month. There were no cases of psoas hematoma, retrograde ejaculation or vascular injury. The postoperative VAS score showed that all the patients achieved satisfactory results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>XLIF at L5-S1 is feasible in strictly selected cases after thorough preoperative preparation and careful intraoperative procedures. However, we did not recommend XLIF as a routine surgical option at the L5\/S1 level.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.995662","type":"journal-article","created":{"date-parts":[[2022,9,27]],"date-time":"2022-09-27T14:07:08Z","timestamp":1664287628000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Extreme lateral interbody fusion (XLIF) approach for L5-S1: Preliminary experience"],"prefix":"10.3389","volume":"9","author":[{"given":"Junjie","family":"Xu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enliang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Le","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaobao","family":"Zou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chenfu","family":"Deng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junlin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rencai","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiangyang","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zenghui","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2014\/603531","article-title":"Miniopen oblique lateral L5-S1 interbody fusion: a report of 2 cases","volume":"2014","author":"Kanno","year":"2014","journal-title":"Case Rep Orthop"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2227","DOI":"10.1097\/00007632-199311000-00014","article-title":"Vascular injury in anterior lumbar surgery","volume":"18","author":"Baker","year":"1993","journal-title":"Spine"},{"key":"B3","doi-asserted-by":"publisher","first-page":"60","DOI":"10.3171\/spi.1999.91.1.0060","article-title":"Visceral and vascular complications resulting from anterior lumbar interbody fusion","volume":"91","author":"Rajaraman","year":"1999","journal-title":"J Neurosurg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1016\/j.spinee.2009.04.004","article-title":"Complications associated with single-level transforaminal lumbar interbody fusion","volume":"9","author":"Rihn","year":"2009","journal-title":"Spine J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1097\/01.bsd.0000185277.14484.4e","article-title":"Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability","volume":"19","author":"Villavicencio","year":"2006","journal-title":"J Spinal Disord Tech"},{"key":"B6","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1097\/BSD.0000000000000584","article-title":"Use of an alternative surgical corridor in oblique lateral interbody fusion at the L5-S1 segment: a technical report","volume":"31","author":"Chung","year":"2018","journal-title":"Clin Spine Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"E14","DOI":"10.3171\/2020.6.FOCUS20335","article-title":"The anterior-to-psoas approach for interbody fusion at the L5-S1 segment: clinical and radiological outcomes","volume":"49","author":"Miscusi","year":"2020","journal-title":"Neurosurgery Focus"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2018.9.SPINE18800","article-title":"Complications for minimally invasive lateral interbody arthrodesis: a systematic review and meta-analysis comparing prepsoas and transpsoas approaches","volume":"25","author":"Walker","year":"2019","journal-title":"J Neurosurg Spine"},{"key":"B9","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/j.spinee.2016.10.026","article-title":"Technical description of oblique lateral interbody fusion at L1\u2013L5 (OLIF25) and at L5\u2013S1 (OLIF51) and evaluation of complication and fusion rates","volume":"17","author":"Woods","year":"2017","journal-title":"Spine J"},{"key":"B10","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/j.spinee.2005.08.012","article-title":"Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion","volume":"6","author":"Ozgur","year":"2006","journal-title":"Spine J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1227\/01.NEU.0000325486.92090.DA","article-title":"Anterior-only approaches to scoliosis","volume":"63","author":"Shamji","year":"2008","journal-title":"Neurosurgery"},{"key":"B12","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1097\/BSD.0b013e3181ecf995","article-title":"Lateral lumbar interbody fusion: clinical and radiographic outcomes at 1 year: a preliminary report","volume":"24","author":"Sharma","year":"2011","journal-title":"J Spinal Disord Tech"},{"key":"B13","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.esas.2010.03.001","article-title":"Fusion after minimally disruptive anterior lumbar interbody fusion: analysis of extreme lateral interbody fusion by computed tomography","volume":"4","author":"Rodgers","year":"2010","journal-title":"SAS J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"E969","DOI":"10.1016\/j.wneu.2018.10.182","article-title":"Cage subsidence and fusion rate in extreme lateral interbody fusion with and without fixation","volume":"122","author":"Chen","year":"2019","journal-title":"World Neurosurg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.neuchi.2019.12.010","article-title":"Long-term complications of minimally-open anterolateral interbody fusion for L5-S1","volume":"66","author":"Abed Rabbo","year":"2020","journal-title":"NeuroChirurgie"},{"key":"B16","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.otsr.2016.11.016","article-title":"Mini-open oblique lumbar interbody fusion (OLIF) approach for multi-level discectomy and fusion involving L5-S1: preliminary experience","volume":"103","author":"Zairi","year":"2017","journal-title":"Orthop Traumatol Surg Res"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2","DOI":"10.3978\/j.issn.2414-469X.2015.10.05","article-title":"Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF\/ATP, LLIF and ALIF","volume":"1","author":"Mobbs","year":"2015","journal-title":"J Spine Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.1097\/BRS.0b013e31825752bc","article-title":"Retrograde ejaculation after anterior lumbar spine surgery","volume":"37","author":"Lindley","year":"2012","journal-title":"Spine"},{"key":"B19","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1016\/j.jvs.2009.11.039","article-title":"Vascular complications of exposure for anterior lumbar interbody fusion","volume":"51","author":"Garg","year":"2010","journal-title":"J Vasc Surg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1007\/s12178-019-09562-6","article-title":"Lateral and oblique lumbar interbody fusion-current concepts and a review of recent literature","volume":"12","author":"Hah","year":"2019","journal-title":"Curr Rev Musculoskelet Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"89","DOI":"10.4184\/asj.2012.6.2.89","article-title":"Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lumbar interbody fusion in 179 patients","volume":"6","author":"Silvestre","year":"2012","journal-title":"Asian Spine J"},{"key":"B22","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1016\/j.spinee.2020.10.016","article-title":"Inclusion of L5-S1 in oblique lumbar interbody fusion-techniques and early complications-a single center experience","volume":"21","author":"Berry","year":"2021","journal-title":"Spine J"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e20014","DOI":"10.1097\/MD.0000000000020014","article-title":"Evaluation of lumbar fusion using the anterior to psoas approach for the treatment of L5\/S1 spondylolisthesis","volume":"99","author":"He","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"B24","doi-asserted-by":"publisher","first-page":"260","DOI":"10.3171\/2010.3.SPINE09766","article-title":"Defining the safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: an anatomical study","volume":"13","author":"Uribe","year":"2010","journal-title":"J Neurosurg Spine"},{"key":"B25","doi-asserted-by":"publisher","first-page":"21925682211049170","DOI":"10.1177\/21925682211049170","article-title":"Location of the femoral nerve in the lateral decubitus versus prone position","author":"Alluri","year":"2021","journal-title":"Global Spine J"},{"key":"B26","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1111\/os.13180","article-title":"A crucial but neglected anatomical factor underneath psoas muscle and its clinical value in lateral lumbar interbody fusion-the cleft of psoas major (CPM)","volume":"14","author":"Ji","year":"2022","journal-title":"Orthop Surg"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.995662\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,27]],"date-time":"2022-09-27T14:07:12Z","timestamp":1664287632000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.995662\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,27]]},"references-count":26,"alternative-id":["10.3389\/fsurg.2022.995662"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.995662","relation":{},"ISSN":["2296-875X"],"issn-type":[{"type":"electronic","value":"2296-875X"}],"subject":[],"published":{"date-parts":[[2022,9,27]]},"article-number":"995662"}}