Direct Lateral Interbody Fusion (DLIF)

Because it involves accessing the spine through the patient's side, the Direct Lateral approach to interbody fusion offers surgeons and their patients a less invasive option for spine surgery.

Unless you've studied anatomy, chances are you've never heard of the psoas (soh-uhs) muscle. One of the "unsung heroes" of the body, this important muscle extends along the length of the lower spine and is responsible for stability, flexion and range of motion in the lower back and hips.

Precisely because of its location, it's also an integral part of a minimally invasive spinal fusion procedure that's been gaining favor in the orthopedic community in recent years. Called direct lateral interbody fusion (DLIF), this approach to spinal fusion allows access to the area to be treated while potentially minimizing disruption of the surrounding soft tissues and anatomical structures.


The DLIF Difference

The DLIF procedure is different from other interbody fusion techniques in that to approach the spine, Dr. Ismail makes a small incision in the skin of the patient's side. Then, using minimally invasive surgical techniques, he creates a narrow passageway through the underlying soft tissues and the psoas muscle — gently separating the fibers of the psoas muscle rather than cutting through it — directly to the vertebra and disc to be treated. This is called the trans-psoas, or Direct Lateral, approach to interbody spinal fusion.

DLIF is one of several minimally invasive spine procedures available today. Other procedures, such as minimally invasive decompression or minimally invasive TLIF, may be recommended depending on your condition. The potential benefits of minimally invasive may include:

  • Shorter hospital stays
  • Smaller incisions and scars
  • Decreased intraoperative blood loss
  • Decreased post-operative medication needed while in the hospital

However, even though DLIF is a minimally invasive procedure, it's important to remember that it is still spine surgery, and therefore not without risk. Potential risks associated with surgery include anesthesia complications, blood clots, allergic reactions and adverse effects due to undiagnosed medical problems, such as silent heart disease.

How it's Done

For a minimally invasive DLIF procedure, the patient is positioned on their side on the operating table — this is called the lateral decubitus position — and sedated under general anesthesia. Dr. Ismail then:

  • Using a flouroscope, a type of real-time x-ray machine used in the operating room, ensures proper positioning of the vertebra to be treated.
  • Makes a small incision in the skin in the patient's side, over the midsection of the disc for a single-level fusion or over the intervening vertebral body for a multi-level fusion.
  • Using flouroscopic guidance, inserts a series of tubular dilators through the soft tissues and fibers of the psoas muscle to create a tiny "tunnel" through which the surgeon may view the spine and perform surgery. During this step, a neuromonitoring device such as the NIM-Eclipse® System may be used to identify the location of and protect spinal nerve roots.
  • Through the tubular "portal", Dr. Ismail:
    • Removes all or part of the affected disc (discectomy)
    • Prepares the bone surfaces of the adjacent vertebrae for fusion
    • Inserts a interbody device and bone graft into the disc space to promote fusion
    • Removes the tubular portal and closes the incision.

Places pedicle screws and rods in the patient's back using the minimally invasive CD HORIZON® SEXTANT® System. This instrumentation is intended to provide additional stabilization while the bone heals or "fuses".