Presented at Clavel Institute 2024 conference in Guatemala
At the 2024 conference organized by the Clavel Institute in Guatemala, Drs. Pablo Clavel and Ignasi Català presented the most innovative advances in spine surgery. They clearly explained how the ALIF, XLIF and TLIF techniques are revolutionizing the treatment of chronic lumbar problems with a minimally invasive approach. Here we explain the essentials.
What is minimally invasive lumbar spinal fusion?
Lumbar fusion is a surgery to stabilize the spine by joining two or more vertebrae, which helps eliminate pain caused by degenerated or unstable discs. Thanks to minimally invasive techniques such as ALIF, XLIF and TLIF, this procedure can now be performed with small incisions, less muscle damage and a much faster recovery.
ALIF: Anterior approach with maximum precision and less damage
ALIF (Anterior Lumbar Interbody Fusion) accesses the lumbar spine through the front of the body, specifically below the navel.
"With ALIF we avoid touching the posterior muscles and nerves directly. Only the skin and abdominal fascia are cut, and the internal structures are gently separated."
What is done during an ALIF?
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- The damaged disc is removed and a fixed implant called a "fusion cage" is placed, which replaces the function of the disc and stabilizes the vertebrae.
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- This box can even replace the use of posterior screws, especially in the so-called "ALIF stalon" approach, which means less invasion and faster recovery.
Outstanding advantages of ALIF:
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- Larger implants: by accessing from the front, a larger box with more bone graft can be placed, improving stability and the likelihood of fusion.
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- Corrects the natural posture: it allows restoring lordosis (natural curvature of the back), something very difficult to achieve from posterior approaches.
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- Ideal for complex cases: such as revision surgeries or patients with multiple previous posterior operations.
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- Key to correcting scoliosis: posture correction can be initiated from the base of the spine.
"In patients with scoliosis or multiple operations via the posterior approach, ALIF is a powerful and safe alternative approach."
Limitations:
The success of ALIF depends on the patient's physical condition. For example, a very protruding belly or calcified blood vessels may make the procedure difficult or impossible up front.
Sequence of anterior ALIF implantation and robotic posterior screw placement for spondylolisthesis correction.
XLIF: The lateral pathway that avoids cutting muscles
XLIF (Extreme Lateral Interbody Fusion) accesses the spine through the side of the abdomen. It is performed with a lateral approach between the fibers of the psoas muscle, with neurophysiological mapping systems that protect the nerves.
Why is it so effective?
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- No muscles are cut: they are carefully separated with dilators, which reduces trauma.
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- Wider cages: XLIF cages can cover up to 50 % of the vertebral plate, providing greater support.
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- Faster recovery: less postoperative pain and fewer days in the hospital.
"With the XLIF system and its nerve mapping technology, we achieve maximum accuracy and safety."
Lateral approaches: advanced technique with nerve protection
During the conference, the doctors also described lateral approaches, a technique very similar to XLIF, although without explicitly using that acronym.
How is it done?
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- The spine is accessed through very small incisions, carefully crossing the psoas muscle.
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- The main challenge is to protect the nerves leading to the legs, which are located under this muscle. If they are not adequately protected, painful neuropathies can occur.
Highlighted clinical case:
A case was presented of a patient with scoliosis treated with three boxes placed laterally with a small incision, and where the screws were placed with the assistance of a surgical robot for maximum precision.
This type of lateral approach offers an advanced solution for complex deformities, with a less aggressive and highly effective approach.
TLIF: the most widely used downstream option
TLIF (Transforaminal Lumbar Interbody Fusion) is a traditional approach from the back. It is performed by removing part of the disc from behind, placing an interbody cage and fixing it with pedicle screws.
When is it recommended?
- In pathologies where the damage is located in the posterior part.
- When ALIF or XLIF are not feasible due to the patient's anatomical conditions.
What benefits do these techniques offer patients?
| Advantage | How does it help you? |
|---|---|
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Less invasive surgery |
Small incisions and faster recovery |
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Less pain |
Reduced need for analgesics |
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Brief hospitalization |
Discharge in 2-5 days depending on the case |
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More mobility |
Functional preservation of the spine |
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Options for complex cases |
Ideal for scoliosis, revisions, and deformities |
Clavel Institute: leaders in spine surgery
The Clavel Institute is a reference center in spine surgery in Europe, with offices in Barcelona and Madrid. Its team has pioneered the use of approaches such as ALIF and XLIF, as well as technologies such as the Mazor X robot, the O-ARM 2 scanner, and intraoperative monitoring systems for maximum precision and safety.
In addition, the Institute implements the PERQ (Preparation, Empowerment and Surgical Recovery) program to accompany the patient before, during and after surgery.
Source: "Beyond Traditional Spine Surgery | Clavel Institute | Enlace-Med" Conference 2024
Do you want to know if you are a candidate?
EnlaceMED can help you coordinate your initial evaluation and facilitate a virtual appointment with the doctors at Instituto Clavel.
📩 info@enlace-med.com
📱 +502 3647 5825 (WhatsApp).
