Surgical indications included segmental instability selleck kinase inhibitor for the target disc with combined minimal canal stenosis, degenerative disc disease, disc herniation, and adjacent segment failure.The XLIF procedure was performed as previously described [8]. Patients are positioned in a lateral decubitus position, typically with the side giving the best clearance of the ipsilateral iliac crest or the concave side of any scoliotic curve up. A small incision is made, and a muscle splitting technique is used to gain access to the retroperitoneal space and facilitate localization of the correct disc space under fluoroscopic guidance. A discectomy is performed, endplates prepared, and a 10�� lordotic, PEEK cage (CoRoent XL, NuVasive, San Diego, CA, USA) of either 50, 55, or 60mm in length, 18 or 22 mm in width, and 8 to 10mm in height was implanted.

All cages were filled with allograft [0.7�C1.4mg of recombinant human bone morphogenetic protein-2 (rhBMP-2)(INFUSE, Medtronic, Minneapolis, MN, USA) mixed with hydroxyapatite and tricalcium phosphate (Formagraft, NuVasive, San Diego, CA, USA) per level] or 5cc of cadaveric cancellous bone mixed with mesenchymal stem cells (Osteocel, NuVasive, San Diego, CA). Implants were centered just posterior to half of the disc space. The ALL and PLL were left intact.A 2-screw fixation (one rostral and one caudal) titanium lateral plate (XLP, NuVasive, San Diego, CA, USA) was used in all but one patient (Figure 1). Appropriate positioning and size were fluoroscopically confirmed. The rostral and caudal screw entry points were centered to clear each corresponding endplate as well as the ipsilateral segmental artery.

Screws were placed parallel to the endplates, and bicortical purchase was obtained. The plate was then seated over the screw heads, and the lock nuts were secured. Figure 1XLP lateral plate. (a) Lateral view. Notice the plate spans across the disc space (DS) and is secured down to the vertebral bodies (VB) with lock nuts. (b) AP view. Lateral plate (white arrow) is seated on two bicortical screws, which are parallel to …Preoperative and postoperative upright anterior-posterior and lateral lumbar spine radiographs were obtained in all patients. The most recent postoperative radiographs from routine 6- and 12-week, 6-, 12-, 18-, Cilengitide and 24-month follow-up appointments were used for comparison.Lordosis measurements were made on lateral radiographs.