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Surgical Technique of Vertebral Body Removal and Anterior Reconstruction in L5 Spondylectomy
INTRODUCTION: L5 spondylectomy for the treatment of spinal tumor is a technically demanding surgery because of the complex anatomy of major vessels, the obscurity of the posterior exposure from the iliac wings, and the increased comparative size of the L5 vertebral body. In this study, we present a...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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The Japanese Society for Spine Surgery and Related Research
2018
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698529/ https://www.ncbi.nlm.nih.gov/pubmed/31440675 http://dx.doi.org/10.22603/ssrr.2018-0014 |
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author | Sangsin, Apiruk Murakami, Hideki Shimizu, Takaki Kato, Satoshi Demura, Satoru Tsuchiya, Hiroyuki |
author_facet | Sangsin, Apiruk Murakami, Hideki Shimizu, Takaki Kato, Satoshi Demura, Satoru Tsuchiya, Hiroyuki |
author_sort | Sangsin, Apiruk |
collection | PubMed |
description | INTRODUCTION: L5 spondylectomy for the treatment of spinal tumor is a technically demanding surgery because of the complex anatomy of major vessels, the obscurity of the posterior exposure from the iliac wings, and the increased comparative size of the L5 vertebral body. In this study, we present a surgical technique of L5 spondylectomy, vertebral body removal, and anterior reconstruction for a case with solitary spinal metastatic renal cell carcinoma (RCC). TECHNICAL NOTE: A 54-year-old man underwent right total nephrectomy for RCC one year ago. At the one-year postoperative follow-up, CT scan and MRI revealed a solitary L5 spinal metastasis. A two-stage posteroanterior approach was performed. To facilitate vertebral body removal, transverse processes were separated from the vertebral body by using the posterior approach. On the basis of the anterior approach, the vertebral body was removed via the interval space between the left common iliac vessels. Reconstruction was performed by using a liquid-nitrogen-frozen, tumor-bearing bone mixed with an autogenous bone graft in an expandable titanium cage. RESULTS: No intraoperative complications were observed. Postoperatively, the patient exhibited muscle weakness in the tibialis anterior and extensor hallucis longus bilaterally but improved with time. Seven months after the operation, the patient was able to walk independently. At the recent 2.5-year follow-up, the local recurrence of lesions was nonexistent. The bone graft had fused with the adjacent vertebrae. CONCLUSION: This report described a novel technique for L5 spondylectomy that can facilitate safe L5 vertebral body removal and demonstrated the effectiveness of liquid-nitrogen-frozen, tumor-bearing bone mixed with autogenous bone graft in anterior reconstruction both in terms of oncologic safety and biological healing. |
format | Online Article Text |
id | pubmed-6698529 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | The Japanese Society for Spine Surgery and Related Research |
record_format | MEDLINE/PubMed |
spelling | pubmed-66985292019-08-22 Surgical Technique of Vertebral Body Removal and Anterior Reconstruction in L5 Spondylectomy Sangsin, Apiruk Murakami, Hideki Shimizu, Takaki Kato, Satoshi Demura, Satoru Tsuchiya, Hiroyuki Spine Surg Relat Res Technical Note INTRODUCTION: L5 spondylectomy for the treatment of spinal tumor is a technically demanding surgery because of the complex anatomy of major vessels, the obscurity of the posterior exposure from the iliac wings, and the increased comparative size of the L5 vertebral body. In this study, we present a surgical technique of L5 spondylectomy, vertebral body removal, and anterior reconstruction for a case with solitary spinal metastatic renal cell carcinoma (RCC). TECHNICAL NOTE: A 54-year-old man underwent right total nephrectomy for RCC one year ago. At the one-year postoperative follow-up, CT scan and MRI revealed a solitary L5 spinal metastasis. A two-stage posteroanterior approach was performed. To facilitate vertebral body removal, transverse processes were separated from the vertebral body by using the posterior approach. On the basis of the anterior approach, the vertebral body was removed via the interval space between the left common iliac vessels. Reconstruction was performed by using a liquid-nitrogen-frozen, tumor-bearing bone mixed with an autogenous bone graft in an expandable titanium cage. RESULTS: No intraoperative complications were observed. Postoperatively, the patient exhibited muscle weakness in the tibialis anterior and extensor hallucis longus bilaterally but improved with time. Seven months after the operation, the patient was able to walk independently. At the recent 2.5-year follow-up, the local recurrence of lesions was nonexistent. The bone graft had fused with the adjacent vertebrae. CONCLUSION: This report described a novel technique for L5 spondylectomy that can facilitate safe L5 vertebral body removal and demonstrated the effectiveness of liquid-nitrogen-frozen, tumor-bearing bone mixed with autogenous bone graft in anterior reconstruction both in terms of oncologic safety and biological healing. The Japanese Society for Spine Surgery and Related Research 2018-07-27 /pmc/articles/PMC6698529/ /pubmed/31440675 http://dx.doi.org/10.22603/ssrr.2018-0014 Text en Copyright © 2018 by The Japanese Society for Spine Surgery and Related Research https://creativecommons.org/licenses/by-nc-nd/4.0/ Spine Surgery and Related Research is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Technical Note Sangsin, Apiruk Murakami, Hideki Shimizu, Takaki Kato, Satoshi Demura, Satoru Tsuchiya, Hiroyuki Surgical Technique of Vertebral Body Removal and Anterior Reconstruction in L5 Spondylectomy |
title | Surgical Technique of Vertebral Body Removal and Anterior Reconstruction in L5 Spondylectomy |
title_full | Surgical Technique of Vertebral Body Removal and Anterior Reconstruction in L5 Spondylectomy |
title_fullStr | Surgical Technique of Vertebral Body Removal and Anterior Reconstruction in L5 Spondylectomy |
title_full_unstemmed | Surgical Technique of Vertebral Body Removal and Anterior Reconstruction in L5 Spondylectomy |
title_short | Surgical Technique of Vertebral Body Removal and Anterior Reconstruction in L5 Spondylectomy |
title_sort | surgical technique of vertebral body removal and anterior reconstruction in l5 spondylectomy |
topic | Technical Note |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698529/ https://www.ncbi.nlm.nih.gov/pubmed/31440675 http://dx.doi.org/10.22603/ssrr.2018-0014 |
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