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Direct Lateral Interbody Fusion (DLIF)

What is DLIF?

DLIF is the acronym for Direct Lateral Interbody Fusion which is a minimally invasive surgical procedure to create support for the intervertebral discs through the patient’s side. It is a novel approach to treat leg or back pain due to herniated disc or spinal deformities. It has many advantages that include preserving back muscles, lessened blood loss during surgery, minimal incisions, and rapid recovery. The technique is gaining popularity around the world – judging from the majority of recommendations by surgeons – for treating chronic back pain due to herniated disc, degenerative disc disease, or scoliosis among the elderlies, etc.

Benefits of DLIF

Because DLIF procedure approaches the affected area from the side of the body, the patient’s major back muscles are circumvented. This technique requires only small incisions which result in smaller wounds than the traditional method – reducing discomfort and recovery time. As there is no need to operate through major back muscles, there is less bleeding. The patient can recover quickly and return to regular routines within a short time.

During the procedure, the surgeon uses intraoperative neuromonitoring (IOM) device to monitor the progress. A small probe – of about 1 inch in size – is inserted to observe the patient’s spinal cord and neurological activities. The damaged disc is then replaced with an implant which will help strengthen the spine, allowing it to support the patient’s body weight and, thus, mitigates the back pain.

Moreover, this technique can be used to effectively correct spondylolisthesis as well as scoliosis conditions among seniors without having to operate through major back muscles or damaging any spinal joint. It helps alleviate chronic back pain with less adverse effects than the traditional method by avoiding problems with epidural adhesion, loosened fasteners, or weakened back muscles.

DLIF, therefore, is a novel alternative for patients with back pain from many different causes. By making incisions from the patient’s side to help strengthen the spine, this technique increases the success rate while reducing complications from the surgery.

The direct-lateral method addresses many concerns of experienced orthopedic surgeons who treat patients with back pain. It is believed DLIF will become another widely accepted procedure for spinal surgery in the future.

Reduced Recuperation Time

Experience from post-surgery care indicates that patients who have undergone DLIF are able to walk within 48 hours of the procedure, can resume their regular routines and exercises within 3 months. This is because the spine is able to heal more quickly than the traditional procedure, which generally takes up to 6 months or more – resulting in muscles loss.

Furthermore, by approaching the problem area laterally, spinal integrity is preserved and the damaged vertebrae can be repaired easily. Even in the elderly groups, because DLIF does not touch or disturb the nervous system, it enables better recovery and reduces the possibility of post-surgery complications – such as accidental dural tear. Importantly, DLIF also mitigate the risk of future epidural adhesion which may subsequently cause lingering pain.

The DLIF Technique.  It is very beneficial for handling problems with the higher vertebrae. For example, for L1 to L3 – which are the central nerves for upper legs and excretory functions, and are located in a very condensed space – using DLIF does not require interfering with any nerve in the area, thus reducing the risk of any adverse effect to the nervous system. 

Particularly, because the major muscles do not suffer damages from the procedure, the patient’s body can endure physical therapy more readily. During surgery, blood loss is estimated to be about 50 to 80 cc per vertebra, compared to 300 to 500 cc in the traditional method. As for the incision size, DLIF calls for only 4 cm instead of 10 cm. Additionally, DLIF reduces the potential for post-surgery infection amongst seniors, and alleviates leg pains as well as numbness and weakened muscles due to herniated disc.

Recuperation after the Operation. It is recommended that the patient follow a program to start walking immediately and to increase the number of steps each day. Generally, the regiment includes about 15 minutes of walking 2 or 3 times a day, and then 30 to 40 minutes twice daily 6 weeks after the procedure. However, this will depend on the health of each patient and the extent of the surgery.

Important Notes.  The patient must refrain from smoking or using any product that contains nicotine before the surgery and at least 3 months afterwards, as this will increase the chance for success of all types of spinal operation. In particular, nicotine will delay progress of the transplant, preventing it from taking hold and consequently causes the procedure to fail. Further, nicotine may cause the inserted screws or the transplant to come loose or slip.

Crucially, if there is any warning symptom – such as shooting pain down the leg, chronic back pain that requires medication for more than a month, or inability to hold urine – it is vital to seek medical advice for a better quality of life.

Sources :

Gp. Capt. Dr. Tayard Buranakarl, Spinal Surgeon, Bangkok International Hospital

Dr. Kamolwan Chalermchokchai,  Regenerative Medicine, Bangkok International Hospital 

For more information, please contact  

Tel. 0 2310 3000 or  1719

Email: [email protected]