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Erschienen in: International Orthopaedics 12/2017

21.07.2017 | Original Paper

Posterior only approach for fifth lumbar corpectomy: indications and technical notes

verfasst von: Belal Elnady, Ahmad Shawky, Hamdan Abdelrahman, Essam Elmorshidy, Mohamed El-Meshtawy, Galal Zaki Said

Erschienen in: International Orthopaedics | Ausgabe 12/2017

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Abstract

Purpose

To evaluate the efficacy and safety of a posterior-only approach for L5 corpectomy, with lumbopelvic fixation for treatment of secondaries, infections, or burst fractures.

Methods

Between 2010 and 2013, 17 patients with L5 pathology had corpectomy through a posterior-only approach, with reconstruction of the anterior column using titanium cages filled with bone graft. The indication for surgery was presence of secondaries in nine patients, spondylitis and spondylodiscitis in five patients and burst fractures due to high energy trauma in three patients. All patients underwent detailed neurological examination as well as plain radiography, computed tomography, and magnetic resonance imaging studies.

Results

This study included 17 patients (8 males and 9 females) with a mean age of 48.3 years. The mean operative time was 186.1 minutes with mean blood loss of 744 ml. No intra-operative or immediate post-operative complications were encountered. Three patients died during follow-up due to advanced malignancy. The remaining 14 patients were followed-up for a mean of 24.9 months. One patient had cut through of L3 screws two years after surgery requiring metal removal. One patient had asymptomatic broken screw, with no need for further intervention.

Conclusions

L5 corpectomy is a challenging procedure indicated for treatment of various cases of metastasis, infections, or comminuted fractures. The posterior approach is safe, efficient, and allows both rigid posterior stabilization and anterior reconstruction after L5 corpectomy without the need for an anterior approach and its possible related morbidity.
Literatur
1.
Zurück zum Zitat Shousha M, El-Saghir H, Boehm H (2014) Corpectomy of the fifth lumbar vertebra, a challenging procedure. J Spinal Disord Tech 27(6):347–351CrossRefPubMed Shousha M, El-Saghir H, Boehm H (2014) Corpectomy of the fifth lumbar vertebra, a challenging procedure. J Spinal Disord Tech 27(6):347–351CrossRefPubMed
2.
Zurück zum Zitat Gallia GL, Sciubba DM, Bydon A, Suk I, Wolinsky J-P, Gokaslan ZL et al (2007) Total L-5 spondylectomy and reconstruction of the lumbosacral junction. J Neurosurg Spine 7(1):103–111CrossRefPubMed Gallia GL, Sciubba DM, Bydon A, Suk I, Wolinsky J-P, Gokaslan ZL et al (2007) Total L-5 spondylectomy and reconstruction of the lumbosacral junction. J Neurosurg Spine 7(1):103–111CrossRefPubMed
3.
Zurück zum Zitat Shimada Y, Hongo M, Miyakoshi N, Kasukawa Y, Ando S, Itoi E et al (2007) Giant cell tumor of fifth lumbar vertebrae: two case reports and review of the literature. Spine J 7(4):499–505CrossRefPubMed Shimada Y, Hongo M, Miyakoshi N, Kasukawa Y, Ando S, Itoi E et al (2007) Giant cell tumor of fifth lumbar vertebrae: two case reports and review of the literature. Spine J 7(4):499–505CrossRefPubMed
4.
Zurück zum Zitat Detwiler PW, Porter RW, Crawford NR, Apostolides PJ, Dickman CA (1999) Lumbosacral junction fixation and fusion after complete L-5 spondylectomy: case report. Neurosurg Focus 7(6):E5CrossRef Detwiler PW, Porter RW, Crawford NR, Apostolides PJ, Dickman CA (1999) Lumbosacral junction fixation and fusion after complete L-5 spondylectomy: case report. Neurosurg Focus 7(6):E5CrossRef
5.
Zurück zum Zitat Kocis J, Wendsche P, Visna P (2008) Complete burst fracture of the fifth lumbar vertebra treated by posterior surgery using expandable cage. Acta Neurochir 150(12):1301–1305CrossRefPubMed Kocis J, Wendsche P, Visna P (2008) Complete burst fracture of the fifth lumbar vertebra treated by posterior surgery using expandable cage. Acta Neurochir 150(12):1301–1305CrossRefPubMed
6.
Zurück zum Zitat Hunt T, Shen FH, Arlet V (2006) Expandable cage placement via a posterolateral approach in lumbar spine reconstructions: technical note. J Neurosurg Spine 5(3):271–274CrossRefPubMed Hunt T, Shen FH, Arlet V (2006) Expandable cage placement via a posterolateral approach in lumbar spine reconstructions: technical note. J Neurosurg Spine 5(3):271–274CrossRefPubMed
7.
Zurück zum Zitat Roy-Camille R, Saillant G, Mazel C (1986) Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res 203:7–17 Roy-Camille R, Saillant G, Mazel C (1986) Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res 203:7–17
8.
Zurück zum Zitat Kaner T, Oktenoglu T, Sasani M, Ozer AF (2012) L5 vertebrectomy for the surgical treatment of tumoral and traumatic lesions of L5 vertebra. Orthop Rev 4(1):10CrossRef Kaner T, Oktenoglu T, Sasani M, Ozer AF (2012) L5 vertebrectomy for the surgical treatment of tumoral and traumatic lesions of L5 vertebra. Orthop Rev 4(1):10CrossRef
9.
Zurück zum Zitat Harms J, Tabasso G, Cinanni R (1999) Instrumented spinal surgery: principles and technique. Thieme, Stuttgart Harms J, Tabasso G, Cinanni R (1999) Instrumented spinal surgery: principles and technique. Thieme, Stuttgart
10.
Zurück zum Zitat Brau SA, Delamarter RB, Schiffman ML, Williams LA, Watkins RG (2004) Vascular injury during anterior lumbar surgery. Spine J 4(4):409–412CrossRefPubMed Brau SA, Delamarter RB, Schiffman ML, Williams LA, Watkins RG (2004) Vascular injury during anterior lumbar surgery. Spine J 4(4):409–412CrossRefPubMed
11.
Zurück zum Zitat El-Sharkawi MM, Said GZ (2012) Instrumented circumferential fusion for tuberculosis of the dorso-lumbar spine. A single or double stage procedure? Int Orthop 36(2):315–324CrossRefPubMed El-Sharkawi MM, Said GZ (2012) Instrumented circumferential fusion for tuberculosis of the dorso-lumbar spine. A single or double stage procedure? Int Orthop 36(2):315–324CrossRefPubMed
12.
Zurück zum Zitat Kuklo TR, Potter BK, Bell RS, Moquin RR, Rosner MK (2006) Single-stage treatment of pyogenic spinal infection with titanium mesh cages. J Spinal Disord Tech 19(5):376–382CrossRefPubMed Kuklo TR, Potter BK, Bell RS, Moquin RR, Rosner MK (2006) Single-stage treatment of pyogenic spinal infection with titanium mesh cages. J Spinal Disord Tech 19(5):376–382CrossRefPubMed
13.
Zurück zum Zitat Fayazi AH, Ludwig SC, Dabbah M, Butler RB, Gelb DE (2004) Preliminary results of staged anterior debridement and reconstruction using titanium mesh cages in the treatment of thoracolumbar vertebral osteomyelitis. Spine J 4(4):388–395CrossRefPubMed Fayazi AH, Ludwig SC, Dabbah M, Butler RB, Gelb DE (2004) Preliminary results of staged anterior debridement and reconstruction using titanium mesh cages in the treatment of thoracolumbar vertebral osteomyelitis. Spine J 4(4):388–395CrossRefPubMed
14.
Zurück zum Zitat Dai L-Y, Jiang L-S (2010) Anterior-only instrumentation and grafting after L5 corpectomy for non-traumatic lesions. Acta Orthop Belg 76(1):94PubMed Dai L-Y, Jiang L-S (2010) Anterior-only instrumentation and grafting after L5 corpectomy for non-traumatic lesions. Acta Orthop Belg 76(1):94PubMed
15.
Zurück zum Zitat Lee Y-P, Ghofrani H, Regev GJ, Garfin SR (2011) A retrospective review of long anterior fusions to the sacrum. Spine J 11(4):290–294CrossRefPubMed Lee Y-P, Ghofrani H, Regev GJ, Garfin SR (2011) A retrospective review of long anterior fusions to the sacrum. Spine J 11(4):290–294CrossRefPubMed
16.
Zurück zum Zitat Cunningham BW, Lewis SJ, Long J, Dmitriev AE, Linville DA, Bridwell KH (2002) Biomechanical evaluation of lumbosacral reconstruction techniques for spondylolisthesis: an in vitro porcine model. Spine 27(21):2321–2327CrossRefPubMed Cunningham BW, Lewis SJ, Long J, Dmitriev AE, Linville DA, Bridwell KH (2002) Biomechanical evaluation of lumbosacral reconstruction techniques for spondylolisthesis: an in vitro porcine model. Spine 27(21):2321–2327CrossRefPubMed
Metadaten
Titel
Posterior only approach for fifth lumbar corpectomy: indications and technical notes
verfasst von
Belal Elnady
Ahmad Shawky
Hamdan Abdelrahman
Essam Elmorshidy
Mohamed El-Meshtawy
Galal Zaki Said
Publikationsdatum
21.07.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
International Orthopaedics / Ausgabe 12/2017
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-017-3570-7

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