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FLIF—Far Lateral Lumbar Interbody Fusion: Dr. Antonacci’s Approach

M. Darryl Antonacci MD, FACS
M. Darryl Antonacci MD, FACS
Chief Spine Surgeon & Director Specialist in Pediatric & Adult Spine

Page Contents:

FLIF—Far Lateral Lumbar Interbody Fusion: Dr. Antonacci’s Approach 1

Who Should Consider Far Lateral Interbody Fusion?

Any spinal reconstruction procedure is possibly appropriate for the far lateral interbody fusion (FLIF) procedure. Patients with conditions such as low- and high-grade spondylolisthesis, scoliosis, stenosis, kyphosis, herniated disc, flatback or discogenic back pain may benefit from FLIF as a less invasive procedure. Blood loss and operative time is of special concern for patients needing spinal reconstructive surgery (*see below), therefore Dr. Antonacci’s approach is ideal for reduction of blood loss and decreased operative times.

How Does the Far Lateral Interbody Fusion (FLIF) Procedure Work?

FLIF uses a back muscle-sparing approach for accomplishing a less invasive surgery. After the skin incision, rather than cut the back muscles and dissect them away from the spine as is done in traditional or typical spinal surgeries, Dr. Antonacci uses a natural interval between the back muscles – a natural plane called the inter-muscular plane. This naturally muscle-sparing approach better protects your back muscles from the damage caused by typical spine surgery, improves recovery times dramatically, shortens hospital stays, and preserves midline structures, thereby reducing potential junctional problems in the future. In revision surgeries, it also avoids prior scar tissue planes. Because Dr. Antonacci’s technique provides excellent visualization, there is less blood loss and less risk. It allows for complete decompression of the spinal canal, complete discectomy, interbody fusion, and spinal reconstruction with less collateral damage.

What are the Advantages of Far Lateral Interbody Fusion?

Typically surgery that is less invasive will carry less risk for the patient for several reasons. In the case of the FLIF procedure, surgical time is greatly decreased, as is average blood loss during surgery. These and other factors, therefore, result in reduced length of hospital stay, making surgery less inconvenient for both patient and family.

The FLIF Approach Results

The FLIF approach results in decreased surgical time, blood loss, and length of hospital stay

 Single level2-3 levels> 3 levels
LOS1-2 days2-3 days4 days
Surgical time1.5 hours2.25 hoursAdd 30 minutes per level > 3
Blood loss< 250250-400600


*Typically, one level spinal reconstruction surgeries with Dr. Antonacci’s FLIF technique have hospitals stays of 1 day, and operative times of under 1.5 hours. Spinal reconstruction surgeries with two levels have stays of 1-2 days and operative times of 1.5-2 hours; surgeries with three levels have stays of 2-3 days and operative times averaging 2.5 hours. These operative times and hospital stays for Dr. Antonacci’s patients are dramatically less than most other spinal surgeons and represent the true benefit of his pioneering procedure and his years of experience and expertise. (Peer-reviewed data at the 18th International Meeting on Advanced Spine Techniques – IMAST, Copenhagen, Denmark, July 2011

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