Concierge spinal surgery · UK
Lateral lumbar interbody fusion (XLIF), by a consultant spinal surgeon.
A minimally invasive lateral trans-psoas approach to lumbar fusion — with a named BASS-member surgeon, full intra-operative neuromonitoring, and TLIF, PLIF and ALIF alternatives honestly compared before you commit.
Why patients choose us
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A consultant spinal surgeon, in theatre
Not a generalist and not a trainee. A named BASS-member spinal surgeon, a proper theatre with neuromonitoring, and an anaesthetist who knows lateral positioning.
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Alternatives to XLIF on the table
For some patients TLIF, PLIF or ALIF is the better answer. We say so before you commit to a lateral approach.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private XLIF costs in the UK.
Indicative ranges across our partner hospitals. Send the details and we quote firm figures across two or three surgeons.
In short
A single-level XLIF with posterior fixation in our network: £15,000–£30,000, home in 3–5 days.
| Procedure | Indicative range | Typical duration | Hospital stay |
|---|---|---|---|
| Single-level XLIF + posterior fixation | £15,000–£30,000 | 2–4 hr GA | 3–5 day stay |
| Two-level XLIF + posterior fixation | £20,000–£38,000 | 3–5 hr GA | 3–5 day stay |
| Multi-level XLIF (3+ levels, deformity) | £25,000–£45,000 | 4–6 hr GA | 5–7 day stay |
| XLIF as stand-alone (selected cases) | £12,000–£22,000 | 2–3 hr GA | 2–3 day stay |
| Revision / adjacent segment XLIF | £18,000–£35,000 | 3–5 hr GA | 3–5 day stay |
| Spinal surgeon consultation | £250–£450 | 45 min | Same visit |
Prices vary by hospital, by which surgeon does the case, by the number of levels fused, by the implants used (PEEK versus titanium, standard versus hyperlordotic) and by whether BMP or other biologics are added. We come back with a firm quote within one working day.
The problem
The right surgeon, the right approach, the right level.
Lumbar fusion is one of the most over-marketed and under-explained operations in the private market — patients are steered to a favourite approach, alternatives never surface, and the wrong level is sometimes chosen. We fix all three before you commit.
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Not sure it is needed?
Conservative care and targeted injections might do the job. We say so before you agree to a fusion.
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Is XLIF right for your level?
L2–L3, L3–L4 and L4–L5 are lateral corridors. L5–S1 is not — that level needs ALIF or TLIF. We check your imaging first.
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Want it done properly?
A named BASS-member spinal surgeon, full intra-operative neuromonitoring, and a hospital equipped for lateral positioning and prone screws in the same session.
The journey
From enquiry to fusion review — what happens, in order.
One clinician from first message to 12-month fusion review — including the recovery window.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A day in hospital
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Back and leg symptoms, prior imaging, previous surgery, medications.
- 02
Before
We come back with a recommendation
Within one working day: the right approach (XLIF, TLIF, PLIF or ALIF), the right surgeon, an indicative price. If fusion is not the right step, we say so.
- 03
Before
Imaging and workup
MRI, CT, standing X-ray, flexion-extension views and a DEXA are reviewed. A CT angiogram of the lumbar arteries rules out aberrant vessels. NSAIDs stop one week before.
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On the day
Arrival at the hospital
Admission, consent and a chat with the surgeon and anaesthetist. Lateral decubitus positioning is planned to the side that suits the pathology.
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On the day
The procedure itself
Two to four hours under GA with fluoroscopy and continuous EMG, SSEP and MEP neuromonitoring. A 3–4 cm lateral incision, retroperitoneal approach, trans-psoas cage placement, then prone percutaneous pedicle screws.
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On the day
HDU or ward that night
HDU for 24–48 hours if multi-level, otherwise straight to the ward. Mobilising with physio from day one.
- 07
After
Recovery and review
Home at 3–5 days. Office work at 4–8 weeks, no heavy lifting or gym for 12 weeks. Review at 6 weeks, 3 months and 12 months with imaging to confirm fusion.
Typical end-to-end: 3–6 weeks from enquiry to surgery. Fusion on CT: 12 months.
When it helps
When XLIF is the right step.
The situations we see most, plus the one red flag that means an emergency rather than an appointment.
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Degenerative disc disease with instability
A worn L2–L3, L3–L4 or L4–L5 disc causing mechanical back pain that has failed conservative care.
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Adult degenerative scoliosis
A curved, degenerated lumbar spine where multi-level lateral cages restore height and correct coronal balance.
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Adjacent segment disease
A worn level above or below a previous fusion — XLIF avoids reopening the old posterior scar.
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Recurrent disc herniation with instability
A disc that has re-herniated after discectomy and now shows movement on flexion-extension films.
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Grade I–II spondylolisthesis
A slipped vertebra at L3–L4 or L4–L5 causing back and leg pain — a large lateral cage indirectly decompresses the nerves.
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Spinal stenosis needing fusion
Stenosis with instability where decompression alone would destabilise the segment further.
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Failed back surgery syndrome
Residual instability and mechanical pain after prior lumbar surgery, where a lateral fusion is a cleaner second operation.
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Red flag: cauda equina or new weakness
Saddle numbness, bladder or bowel change or rapidly progressive leg weakness is an emergency — same-day A&E, not a clinic booking.
Procedure options
XLIF is not the only lumbar fusion.
What each option on the table actually involves — and which fits which level and pathology.
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XLIF (extreme lateral)
The classic Nuvasive-style trans-psoas approach through a small lateral incision. Best for L2–L3, L3–L4 and L4–L5.
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DLIF (direct lateral)
The Medtronic variant of the same lateral trans-psoas approach — same corridor, different retractor system.
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LLIF (lateral lumbar interbody)
The generic umbrella term. Covers any lateral trans-psoas fusion from L1–L2 down to L4–L5.
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OLIF (oblique lateral)
An anterior-to-psoas corridor that spares the muscle and can reach L5–S1 in some patients — considered when XLIF is not suitable.
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XLIF stand-alone
A single large cage with integrated screws, no posterior fixation. Reserved for well-selected single-level cases with good bone.
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XLIF + percutaneous pedicle screws
The commonest configuration. Lateral cage first, then prone percutaneous screws and rods for supplemental stability.
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Hyperlordotic cage for deformity
A wedged cage (15–30°) restores lumbar lordosis and sagittal balance in degenerative scoliosis and flat-back deformity.
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Alternative: TLIF, PLIF or ALIF
Posterior (TLIF, PLIF) or anterior (ALIF) approaches are the right answer for L5–S1 and for patients unsuitable for the lateral corridor.
Our vetted UK network
A small panel of spinal surgeons, we picked them.
BASS-member consultant spinal surgeons across London, Manchester, Birmingham, Leeds and Edinburgh. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every spinal surgeon in our network.
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Consultant spinal surgeons, BASS members, high lateral-approach volume
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Continuous EMG, SSEP and MEP neuromonitoring in every case
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TLIF, PLIF, ALIF and OLIF alternatives discussed before XLIF
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Multi-disciplinary review for deformity and revision cases
Safety and recovery
What to expect afterwards — honestly.
XLIF is a well-established minimally invasive fusion with genuine advantages over open TLIF or PLIF — but it has its own specific complications from the psoas dissection and lumbar plexus. Worth knowing, and worth planning for.
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Thigh numbness or pain is common early
Twenty to forty per cent of patients feel thigh or groin numbness, burning or pain from psoas dissection and small nerve traction. Most settle over three to six months.
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Hip flexion can feel weak for weeks
The psoas is dissected to reach the disc. Hip flexion often feels weak for six to twelve weeks and recovers with physio.
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Lumbar plexus injury is uncommon but real
One to three per cent of patients get a femoral nerve or lumbar plexus injury. Most recover, but a small number are left with permanent weakness or numbness.
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Cage subsidence is a known risk
Five to ten per cent of cages sink into the vertebral endplate, higher if the DEXA shows osteoporosis — which is why we screen bone density first.
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Non-union happens in a minority
Five to fifteen per cent of levels fail to fuse and can need revision. Smoking, diabetes and osteoporosis all raise the risk.
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L5–S1 is not accessible from the side
The iliac crest blocks the lateral corridor at L5–S1. That level needs an ALIF or TLIF instead — a lateral approach is the wrong operation there.
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Rare vascular and visceral injury
Injury to the iliac vessels, bowel, ureter or peritoneum is rare but recognised. Pre-op CT angiography is done to plan around aberrant anatomy.
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Twelve weeks before the gym
Walking from day one, office work at 4–8 weeks, no heavy lifting or gym for 12 weeks. A brace is used occasionally, not routinely.
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Red flags after surgery
New leg weakness, spreading redness at the wound, fever, calf swelling or shortness of breath are not normal — call the team or A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever levels were fused, the note the surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Levels fused and approach
Which levels were operated (for example L3–L4 and L4–L5), the side of the lateral approach, and whether supplemental posterior fixation was added.
- 02 Technique
Cage, graft and neuromonitoring
The cage material and lordotic angle, the graft used (autograft, allograft, BMP), and the neuromonitoring traces during psoas dissection.
- 03 Findings
Intra-operative findings
Notes on disc height restored, indirect decompression achieved, any endplate breach, blood loss, and any nerve or vascular concern flagged.
- 04 Impression
Recovery, brace policy, review timing
Read this first: expected recovery, brace policy, when it is safe to return to work, driving and exercise, and when fusion is checked on CT.
Recognised by major UK insurers
Cover for lumbar fusion varies by insurer and by indication — usually funded when medically indicated with imaging correlation and a failed course of conservative care. We confirm cover, pre-authorisation and any excess before booking.
Frequently asked
Everything we get asked about XLIF.
Quick answers on levels, alternatives, risks, cost and recovery.
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What is XLIF and how is it different from TLIF, PLIF or ALIF?
XLIF (extreme lateral interbody fusion) reaches the lumbar disc through a small incision on the side of the body, splitting the psoas muscle rather than stripping the back muscles (TLIF, PLIF) or opening the abdomen (ALIF). It gives a bigger cage, better disc-height restoration and less muscle damage than posterior approaches — but it cannot reach L5–S1.
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Why can’t XLIF be done at L5–S1?
The iliac crest of the pelvis sits in front of the L5–S1 disc from the side, blocking the lateral corridor. For L5–S1 we use ALIF (through the front) or TLIF (from behind). It is one of the first things we check on your imaging before recommending XLIF.
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What are the specific risks of XLIF I should know about?
The distinctive risks are thigh numbness, burning or pain (20–40% early, most resolve by 3–6 months), temporary hip flexion weakness from psoas dissection (usually 6–12 weeks), and a 1–3% risk of lumbar plexus or femoral nerve injury that can occasionally be permanent. Cage subsidence, non-union, infection and DVT are the general fusion risks.
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Do I still need screws in my back after XLIF?
In most cases yes. The commonest configuration is a lateral cage plus prone percutaneous pedicle screws and rods for supplemental stability. Stand-alone XLIF (a large cage with integrated screws and no posterior fixation) is used in selected single-level cases with good bone quality.
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How much does private XLIF cost in the UK?
Roughly £15,000–£30,000 for a single-level XLIF with posterior fixation, and £25,000–£45,000 for multi-level or deformity cases. Stand-alone single-level XLIF is £12,000–£22,000. We confirm a firm figure across two or three surgeons within one working day.
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How long is recovery after XLIF?
You mobilise on day one and go home at 3–5 days. Office work is realistic at 4–8 weeks. No heavy lifting, cycling or gym for 12 weeks. Fusion on CT is checked at 12 months — solid fusion is seen in 85–95% of well-selected patients.
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What is the neuromonitoring for during XLIF?
Continuous EMG, SSEP and MEP monitor the lumbar plexus in real time as the surgeon passes retractors through the psoas muscle. It is not optional — it is the main way to avoid femoral nerve injury and to know exactly where the nerve roots are during dissection.
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When should I go to A&E rather than wait for a clinic appointment?
Saddle numbness, loss of bladder or bowel control, or rapidly progressive weakness in both legs is possible cauda equina syndrome and needs same-day emergency assessment — not an outpatient booking. After surgery, spreading redness, fever, new leg weakness, calf swelling or shortness of breath are also same-day.
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