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

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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.

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Authors and Affiliations

  1. Department of Orthopedic and Trauma Surgery, Assiut University Medical School, Assiut, 71111, Egypt

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

  2. Department of Spine Surgery, Helios Klinikum Erfurt, 99089, Erfurt, Germany

    Ahmad Shawky

  3. Department of Spine Surgery, Zentralklinik Bad Berka, 99438, Bad Berka, Germany

    Hamdan Abdelrahman

Authors
  1. Belal Elnady
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  2. Ahmad Shawky
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  3. Hamdan Abdelrahman
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  4. Essam Elmorshidy
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  5. Mohamed El-Meshtawy
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  6. Galal Zaki Said
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Corresponding author

Correspondence to Belal Elnady.

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All authors certify that they have no financial conflicts of interest in connection with this article.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Elnady, B., Shawky, A., Abdelrahman, H. et al. Posterior only approach for fifth lumbar corpectomy: indications and technical notes. International Orthopaedics (SICOT) 41, 2535–2541 (2017). https://doi.org/10.1007/s00264-017-3570-7

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  • DOI: https://doi.org/10.1007/s00264-017-3570-7

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