Objective: To describe the operative technique of Extreme Lateral Interbody Fusion (XLIF) with emphasis on technical nuances and to evaluate early clinical and radiological outcomes in a consecutive institutional case series.

Methods: A retrospective analysis was performed on 20 consecutive patients who underwent XLIF for degenerative lumbar spine pathology between [year–year] at our institution. Indications included degenerative disc disease, Grade I–II spondylolisthesis, adult degenerative scoliosis, and revision surgery for recurrent disc disease. Operated levels ranged from L2–3 to L4–5. All procedures were performed under continuous multimodal intraoperative neuromonitoring. Supplemental posterior pedicle screw fixation was added in cases of instability, deformity correction, or multilevel disease. Surgical Technique: Patients were positioned in a true lateral decubitus position with strict orthogonal fluoroscopic alignment. A transpsoas approach was performed using sequential dilators guided by directional electromyography to establish a safe working corridor. Following annulotomy, meticulous discectomy and endplate preparation were carried out. A large-footprint interbody cage packed with bone graft was inserted to restore disc height, achieve indirect decompression, and improve segmental alignment. Posterior instrumentation was performed in the same sitting or as a staged procedure based on pathology and intraoperative stability.

Results: The mean operative time was 2-21/2 hr, and mean estimated blood loss was less than 100___ ml. There was a significant improvement in clinical outcomes as measured by Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores at final follow-up. Radiological assessment demonstrated a significant increase in disc height, foraminal height, and improvement in coronal and segmental alignment. Transient ipsilateral thigh dysesthesia occurred in 3 patients and resolved spontaneously within 4–6 weeks. No permanent neurological deficits, vascular injuries, infections, or implant-related complications were observed.

Conclusion: XLIF is a safe and effective minimally invasive technique for selected lumbar degenerative conditions. With careful patient selection, meticulous transpsoas technique, and routine neuromonitoring, XLIF provides reliable indirect decompression and alignment correction with low morbidity. Our institutional experience demonstrates favorable early clinical and radiological outcomes.