Single stage corpectomy and instrumentation in the treatment of pathological fractures in the lumbar spine

Abstract

Purpose Corpectomy and implantation of titanium cages is standard in pathological fracture treatment but additional single ventral instrumentation remains controversial with regard to rotational stability. Methods This study included 45 patients suffering from vertebral metastases with spinal stenosis, instability and/or neurological deficits secondary to pathological lumbar spine fractures and bone mineral density (BMD) ≥1.20 g/ cm 2 . The clinical results of a single stage anterior decompression with corpectomy defect restoration with titanium cage and single double rod system in patients were evaluated at mean 36 months postoperatively with followup neurological and radiological exams at three months then every six months.Evaluation of neurological recovery included grading following a modified Frankel scale. Contentment, disability and actual pain were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI). BMD was measured using dual-energy X-ray absorptiometry (DXA). Results Postoperative neurological evaluations showed improvement in all patients. In the radiological follow-up in 40 patients (89%) findings were similar compared to the postoperative control. In five patients (11%) a loss of correction at a mean of 8°degrees (Cobb angle) secondary to cage subsidence occurred. No breakage of the device or displacement of the instrumentation was seen. Overall the Frankel scale improved 0.65 points (p<0.05) and the ODI improved 40.69 points (p<0.05). Conclusions In lumbar spine fractures of metastatic origin with stenosis, instability and/or neurological deficit, a single stage ventral decompression and instrumentation in patients with BMD ≥1.20 g/cm 2 should be considered.

Corpectomy and Vertebral Body Reconstruction with Expandable Cage Placement and Osteosynthesis via the single stage Posterior Approach: a Retrospective Series of 34 Patients with Thoracic and Lumbar Spine Vertebral Body Tumors

“…Hence, as demonstrated previously (18), decreased durations of procedures and hospital stays, instrumentation, despite controversy about subsequent stability (19) and the anatomical features of our patients (13,21).…”

Five-year clinical and radiological results of combined anteroposterior stabilization of thoracolumbar fractures

“…13,34 Concerning the clinical evaluation, the ODI, although not validated for spinal trauma, is widely accepted as being adequate for the clinical assessment of back problems and reproducible and sensitive enough to detect even minor changes that are clinically significant. In our study, as in the study of Salas et al 30 a satisfactory mean ODI score was already achieved at the 1-year follow-up and, unlike in other studies, 16 it remained practically unchanged afterward. The spinal mobility of the examined patients tended to improve over time, but this improvement failed to reach statistical significance and was not reflected in the ODI score.…”

“…Posterior-only approaches for corpectomy and cage insertion have been recently described, but their potential advantages still remain unclear. 16,24,31 Our study also has some disadvantages. First of all, the relatively low percentage (56%) of the patients able to complete the 5-year follow-up might raise some questions concerning the results of the study.…”

“…16 Some kind of perioperative complication was reported for more than one-third of the patients, but none of these complications was life threatening, and reoperation was needed only in one patient. Existing literature provides varying data in this field, with studies reporting from rather high to very low rates of complications and reoperations.…”

Assessment of long-term kyphosis following transthoracic corpectomy with single adjacent level posterior instrumentation

“…Previous reports exist of successful posterior fixation one level above and one level below a corpectomy in the lumbar and cervical spine following vertebral body fracture; to the best of our knowledge, no previous reports exist of this technique in the thoracic spine. [678] In this location, the ribcage provides additional semi-rigid support and likely contributes to the overall long-term stable spinal alignment observed, suggesting that conclusions drawn from the cervical and lumbar spine may apply to the thoracic spine as well. Multilevel corpectomies with longer anterior column defects result in greater torque on posterior instrumentation; thus, in our clinical practice, we have limited a one-above one-below posterior supplementation to single-level corpectomy operations.…”