The new Lumbar Spinal Fusion technique: Minimally Invasive Trans-psoas approach (Direct Lateral Interbody Fusion (DLIF®)) and a preliminary report of clinical and radiographic success in Bangkok Spine Academy

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Tayard Buranakarl, MD
Kanoknard Jaisanuk, MD


OBJECTIVE. To study the preliminary results in 12 cases who underwent Direct Lateral Interbody Fusion (DLIF) in Bangkok Spine Academy.

MATERIALS AND METHODS. The study of the preliminary results and retrospective chart review of collected clinical and radiographic outcomes in 12 patients who underwent Direct Lateral Interbody Fusion L1-L5 as a treatment for degenerative disc disease, degenerative scoliosis and/or degenerative spondylolisthesis. Clinical outcomes measured include Visual Analog Scale (VAS) and Radiographic outcome.

RESULTS. Twelve patients underwent DLIF between February and July, 2012 with altogether twenty intervertebral disc levels treated. Most cases had indications of back pain with radiation to leg from nerve root compression. Two cases (16.6%) were back pain from a single level severe disc degeneration with signs of instability and unresolved by non-surgical treatment. Five cases (41.7%) were diagnosed with degenerative scoliosis and the other 5 (41.7%) were degenerative spondylolisthesis who did not respond to non-surgical treatment. Mean operative time was 70.6 (±17.7) minutes (mean ± standard deviation). Minimal surgical duration was 41.7 minutes for each level and maximum 110 minutes. Intraoperative blood loss averaged 81.7 mL. Initial pain scores in patient-reported questionnaires (VAS back, VAS legs) showed fast and lasting pain relief and improvement in daily activities. Mean VAS back scores decreased from 5.3 to 0.4. For leg pain assessment, mean VAS scores decreased from 6.3 to 0.3. at the 2 weeks visit. There was a mean correction of 7.9 to 3.2 degrees in segmental coronal plane in all instrumented levels. There was significant change in the overall coronal plane alignment of the lumbar spine. Increasing disc height at middle column 7.0 mm. There were no intraoperative complications. The bleeding during operation was much less than conventional surgery. Neurological examinations showed one patient to have Psoas weakness with anterior thigh numbness, both conditions resolving within 2 weeks.

CONCLUSION. This preliminary short term report of DLIF at Bangkok Spine Academy shows as satisfactory and consistent results as other mini-opened transposes approaches. The benefits of this procedure are reducing leg and back pain, less blood loss, minimized soft tissue injury, wide safety margin of inadvertent complications, especially nerve root injuries, thus less likelihood for long term complications and for lumbar degenerative spine in cases of decompression and fusion.


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Buranakarl T, Jaisanuk K. The new Lumbar Spinal Fusion technique: Minimally Invasive Trans-psoas approach (Direct Lateral Interbody Fusion (DLIF®)) and a preliminary report of clinical and radiographic success in Bangkok Spine Academy. BKK Med J [Internet]. 2012 Sep. 20 [cited 2023 Dec. 11];4(1):61. Available from:
Case Report


1. Ozgur BM, Aryan HE, Pimenta L, et al. Extreme lateral interbody fusion (XLIF): a novel surgical tech nique for anterior lumbar interbody fusion. Spine J 2006;6:435-43.
2. Anand N, Baron EM, Thaiyananthan G, et al. Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis a technique and feasibility study. J Spinal Disord Tech 2008;21:459-67.
3. Marotta N, Cosar M, Pimenta L, et al. A novel minimally invasive presacral approach and instrumentation tech nique for anterior L5-S1 intervertebral discectomy and fusion: technical description and case presentations. Neurosurg Focus 2006;20:E9.
4. Pimenta L, Diaz RC, Phiilips FM, et al. XLIF® for lumbar degenerative scoliosis: outcomes of minimally invasive surgical treatment out to 3 years post-op. Seattle, WA: North American Spine Society, 2006.
5. Baker JK, Reardon PR, Reardon MJ, et al. Vascular injury in anterior lumbar surgery. Spine 1993;18:2227- 223
6. Flynn JC, Price CT. Sexual complications of anterior fusion of the lumbar spine. Spine (Phila Pa 1976) 1984;9:489-92.
7. Brau SA. Mini-open approach to the spine for anterior lumbar interbody fusion: description of the procedure, results and complications. Spine J 2002;2:216-23.
8. Kaiser MG, Haid RW Jr, Suba ch BR, et al. Comparison of the mini-open versus laparoscopic approach for anterior lumbar interbody fusion: a retrospective review. Neurosurgery 2002;51:97-103; discussion 103-5.
9. Chen, MPP*, Tong KB, Laouri M. Surgical treatment patterns among Medicare beneficiaries newly diagnosed with lumbar spinal stenosis. The Spine Journal 2010;10 :588-94.
10. Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 2008;358:794-810.
11. Gibson JN, Waddell G. Surgery for degenerative lumbar spondylosis: updated Cochrane Review. Spine 2005;30: 2312-20.
12. Angus S. Don, FRACS, Eugene Carragee, MD. A brief overview of evidence-informed management of chronic low back pain with surgery. The Spine Journal 2008; 8:258-65. 1
13. Bridwell KH, Sedgewick TA, O’Brien MF, et al. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis wi th spinal stenosis. J Spinal Disord 1993;6:461-72.
14. Hercowitz HN, Kurz LT. Degenerative lumbar spondy lolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am 1991;73:802-8.
15. Fischgrund JS, Mackay M, Herkowitz HN, et al. 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a pro spective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 1997;22:2807-12.
16. Mardjetko SM. Connolly P J, Shott S. Degenerative Lumbar Spondylolisthesis: A Meta-Analysis of Litera ture 1970-1993. Spine 1994;19:2256-65.
17. Kwon B, Katz JN, Kim DH, et al. A review of the 2001 Volvo Award Winner in Clinical Studies. Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish lumbar spine study group. Spine 2006;31:245-9.
18. Gupta MC: Degenerative scoliosis. Options for surgical management. Orthop Clin North Am 2003;34:269-79.
19. Islam N, Wood KB, Transfeldt EE, et al. Extensions of fusions to the pelvis in idiopathic scoliosis. Spine 2001;26:166-73.
20. Shapiro GS, Taira G, Boachie-Adjei O. Results of surgical treatment of adult idiopathic scoliosis with low back pain and spinal stenosis: a study of long-term clinical radiographic outcomes. Spine 2000;28:358- 63.
21. Swan J, Hurwitz E, Malek F, et al. Surgical treatment for unstable low-grade isthmic spondylolisthesis in adults: a prospective controlled study of posterior instrumented fusion compared with combined anterior posterior fusion. Spine J 2006;6:606-14.
22. Chen DF, Fay LA, Lok J, et al. Increasing neuroforaminal volume by anterior interbody distraction in degenerative lumbar spine. Spine 1995;20:74-9.
23. Ricardo SG. Umeta, Avanzi O. Techniques of lumbar sacral spine fusion in spondylosis: systematic literature review and meta-analysis of randomized clinical trials. The Spine Journal 2001;11:668-76.
24. Chad D. Cole, Todd D. McCall. Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches. Curr Rev Musculoskelet Med 2009; 2:118-26.
25. Christensen FB, Hansen ES, Eiskjaer SP, et al. Cir cumferential lumbar spinal fusion with Brantigan cage versus posterolateral fusion with titanium Cotrel Dubousset instrumentation: a prospective, randomized clinical study of 146 patients. Spine 2002;27:2674-83.
26. Fritzell P, Hagg O, Wessberg P, et al. 2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa) 1976 ;26:2521-32; discussion 2532-24.
27. Rodgers WB, Cox CS, Gerber EJ. Early complications of extreme lateral interbody fusion in the obese. J Spinal Disord Tech 2010 Jan 15. 28. Wright N. XLIF- the United States Experience 2003-4. International Meeting on Advanced Spinal Techniques Banff Alberta, Canada, 2005.