The role of XLIF in spinal revision surgery involving failed interbody implants: a review of technique, outcomes, and indications

Abstract

Background: This review examines the novel application of the Extreme Lateral Interbody Fusion (XLIF) approach for the removal of foreign bodies in the spine, including subsided cages, failed hardware, and other implants. It aims to evaluate the efficacy, safety, and technical considerations of XLIF in this context and compare it to traditional anterior and posterior surgical approaches. Methods: A comprehensive literature search in accordance with PRISMA was conducted using Google Scholar, PubMed/MEDLINE, and the Cochrane Library. Search terms included “extreme lateral interbody fusion,” “lateral lumbar interbody fusion,” “cage retrieval,” “revision surgery,” and “foreign body removal.” Articles were selected based on relevance to XLIF use in foreign body removal and included case reports, clinical trials, and observational studies published in English before April 7, 2025. Results: Seven documented cases met inclusion criteria. The XLIF approach demonstrated advantages such as reduced operative time, blood loss, and shorter hospital stays. It allowed safe access around scar tissue and critical neurovascular structures. The technique was successfully used to remove migrated or failed implants in the lumbar spine with minimal complications, most of which were transient. The approach also enabled the insertion of larger interbody cages, contributing to improved spinal stability and fusion outcomes. Conclusion: The XLIF approach is a promising alternative for foreign body removal in complex spinal revision surgeries. However, potential complications, such as transient nerve injury, underscore the need for careful patient selection and surgical expertise. Further studies are needed to validate its broader clinical application.