# Stand-alone extreme lateral interbody fusion (stand-alone XLIF) to treat radicular symptoms in patients with lumbar degenerative scoliosis: A monocentric observational study

## TL;DR

Stand-alone XLIF is a minimally invasive surgery that provides high symptom relief for frail patients with degenerative scoliosis and radicular pain, avoiding extensive posterior procedures.

## Contribution

Demonstrates the efficacy of stand-alone XLIF as a less invasive alternative for radicular symptoms in degenerative scoliosis.

## Key findings

- Stand-alone XLIF achieved 89.5% radicular symptom relief in degenerative scoliosis patients.
- Most patients avoided posterior instrumentation, reducing surgical risks and recovery time.
- Secondary dorsal decompression improved symptom relief in additional 36.8% of patients.

## Abstract

Extreme lateral interbody fusion (XLIF) is commonly used for scoliosis and spondylolisthesis in conjunction with posterior spinal fixation. Stand-alone XLIF may serve as an intermediate strategy for radicular symptoms in neuroforaminal or spinal canal stenosis with severe coronal imbalance, avoiding extensive posterior fixation in frail patients. This study evaluated its efficacy in treating radicular symptoms in degenerative scoliotic patients without posterior instrumentation.

We retrospectively analyzed 19 patients who underwent stand-alone XLIF and dorsal decompression if required between January 2021–June 2024 for degenerative stenosis due to thoracolumbar scoliosis or listhesis with coronal deformity. Outcomes included symptom relief, revision surgery and radiological features like foraminal height restoration. We correlated initial diagnosis and fused levels with success rates to identify predictive factors.

Patients ranged from 65 to 86 years, 47 % were male and 53 % female. Most (42.1 %) underwent single-level fusion; 31.6 % had up to three levels fused. Radicular symptom relief was achieved in 52.6 % of patients following stand-alone XLIF. An additional 36.8 % experienced symptom relief after secondary dorsal decompression resulting in an overall relief rate of 89.5 %. Two patients (10.5 %) required secondary posterior instrumentation. Complications included retroperitoneal hematoma and cage dislocation.

After stand-alone XLIF, 89.5 % of patients achieved pain relief. This procedure addresses neuroforaminal stenosis via indirect decompression and supports secondary fusion, reducing the need for extensive corrective spondylodesis. It is a viable option for frail patients with degenerative scoliosis and radicular symptoms. However, no long-term follow-up was performed and conclusions regarding durability are limited.

•Stand-alone XLIF achieved 90 % symptom relief in frail scoliosis patients.•Reduced operative time, blood loss, and hospital stay with Stand-alone XLIF.•In most patients posterior instrumentation could be avoided.•Secondary direct decompression may further lead to reduced radicular symptoms.

Stand-alone XLIF achieved 90 % symptom relief in frail scoliosis patients.

Reduced operative time, blood loss, and hospital stay with Stand-alone XLIF.

In most patients posterior instrumentation could be avoided.

Secondary direct decompression may further lead to reduced radicular symptoms.