L5 corpectomy—the lumbosacral segmental geometry and clinical outcome—a consecutive series of 14 patients and review of the literature

Autor: Florian Ringel, Bernhard Meyer, Yu-Mi Ryang, Felix Zibold, Martin Vazan, Jens Gempt, Julia Gerhardt, Insa Janssen
Rok vydání: 2017
Předmět:
Zdroj: Acta Neurochirurgica. 159:1147-1152
ISSN: 0942-0940
0001-6268
DOI: 10.1007/s00701-017-3084-5
Popis: We analyzed the lumbosacral segmental geometry and clinical outcome in patients undergoing L5 corpectomy. Fourteen consecutive patients who underwent L5 (n = 12) or L4 + 5 (n = 2) corpectomy at our department between January 2010 and April 2015 were included. All patients underwent a baseline physical and neurologic examination on admission. The diagnostic routine included MRI and CT scans and, if possible, an upright X-ray of the lumbar spine before and after surgery. The local lordosis angle [L4(L3)-S1] was measured. The most common pathology was infection (N = 7), followed by neoplastic disease (n = 3), pseudarthrosis (n = 2) after previous spinal fusion procedures and burst fractures (n = 2) of the L5 vertebral body. We observed seven complications (2 intraoperative; 5 postoperative) in five (36%) patients. Three patients needed revision surgery because of cage subsidence and/or dislodgement (21%). Additional anterior plating was used in two of the revision surgeries to secure the cage. Two spondylodiscitis patients (14%) with complications died of sepsis. Of the 12 remaining patients, 8 were available for follow-up. L5 corpectomy is a technically challenging but feasible procedure even though the overall complication rate can be as high as 36%. The radiologic and clinical outcome seems to be better in patients with a small lordosis angle between L4(L3) and S1, since an angle of >50 degrees seems to facilitate cage dislodgement. Anterior plating should be considered in these cases to prevent implant failure.
Databáze: OpenAIRE
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