Andrea Piazzolla, Davide Bizzoca, Pedro Berjano, Massimo Balsano, Josip Buric, Stefano Carlucci, Carlo Formica, Matteo Formica, Claudio Lamartina, Corrado Musso, Francesco Tamburrelli, Marco Damilano, Fulvio Tartara, Aldo Sinigaglia, Roberto Bassani, Massimiliano Neroni, Giovanni Casero, Alessio Lovi, Diego Garbossa, Zullo Nicola, Biagio Moretti

January 2021, Volume 30, Issue 1, pp 208 - 216 Original Article Read Full Article 10.1007/s00586-020-06542-0

First Online: 03 August 2020

Major complications in extreme lateral interbody fusion access: multicentric study by Italian S.O.L.A.S. group


The eXtreme Lateral Interbody Fusion (XLIF) approach has gained increasing importance in the last decade. This multicentric retrospective cohort study aims to assess the incidence of major complications in XLIF procedures performed by experienced surgeons and any relationship between the years of experience in XLIF procedures and the surgeon’s rate of severe complications.


Nine Italian members of the Society of Lateral Access Surgery (SOLAS) have taken part in this study. Each surgeon has declared how many major complications have been observed during his surgical experience and how they were managed. A major complication was defined as an injury that required reoperation, or as a complication, whose sequelae caused functional limitations to the patient after one year postoperatively. Each surgeon was finally asked about his years of experience in spine surgery and XLIF approach. Pearson correlation test was used to evaluate the association between the surgeon’s years of experience in XLIF and the rate of major complications; a p-value of last than 0.05 was considered significant.


We observed 14 major complications in 1813 XLIF procedures, performed in 1526 patients. The major complications rate was 0.7722%. Ten complications out of fourteen needed a second surgery. Neither cardiac nor respiratory nor renal complications were observed. No significant correlation was found between the surgeon's years of experience in the XLIF procedure and the number of major complications observed.


XLIF revealed a safe and reliable surgical procedure, with a very low rate of major complications, when performed by an expert spine surgeon.

Read Full Article