Disc disruption leading to dessication depressurization and loss in disc height may result in exit foraminal stenosis.
Foraminal stenosis is difficult to treat by decompression alone as the height of the neural foramen is determined by the height of the disc.
Possible solutions to reconstruct disc height are the interbody fusion techniques:
1. Anterior Lumbar Interbody Fusion - ALIF
2. Posterior Lumbar Interbody Fusion - PLIF
3. Transforaminal Lumbar Interbody Fusion - TLIF
4. Axial Lumbar Interbody Fusion - AxiaLIF (transsacral approach to L5-S1 +/- L4-5)
5. eXtreme Lateral Interbody Fusion / Direct Lateral Interbody Fusion - XLIF / DLIF
Each technique has its own advantages and disadvantages.
PLIF and TLIF can allow good canal decompression and are probably the most versatile in that the majority of pathology can be addressed.
ALIF (and AxiaLIF) DLIF and XLIF can be utilized when a posterior approach is difficult due to previous posterior surgery or epidural scarring.
All methods provide for stabilization, decompression with ALIF, AxiaLIF DLIF/XLIF are indirect and due to restoration of disc height.
Whilst ALIF is still considered an open type approach with the risks of anterior lumbar approach, XLIF/ DLIF TLIF PLIF and AxiaLIF can be performed via minimal access techniques with smaller wound sizes.
AxiaLIF (TranS1) is considered the newest of the techniques with >10000 cases performed worldwide mainly in US. Risk of nerve injury is virtually zero with this technique. For more details: