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

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Abstract

Purpose

We analyzed the lumbosacral segmental geometry and clinical outcome in patients undergoing L5 corpectomy.

Methods

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.

Results

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.

Conclusion

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.

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Author notes

    Authors and Affiliations

    1. Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany

      Martin Vazan, Yu-Mi Ryang, Julia Gerhardt, Insa Janssen, Florian Ringel, Jens Gempt & Bernhard Meyer

    2. Zentrum für Wirbelsäulentherapie, Städtisches Klinikum Dresden, Dresden, Germany

      Martin Vazan

    3. Department of Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany

      Felix Zibold

    4. Neurosurgical Center, Medical University of Mainz, Mainz, Germany

      Florian Ringel

    Authors
    1. Martin Vazan
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    2. Yu-Mi Ryang
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    Corresponding author

    Correspondence to Martin Vazan.

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    Funding

    No funding was received for this research.

    Conflict of interest

    B.M.: Consulting: DepuySynthes, Brainlab, Medtronic, Ulrich, Spineart, Reliviant. Received funding from: DepuySynthes, Brainlab, Medtronic, Ulrich, Reliviant. Royalties/Patent: Ulrich, Spineart.

    J.G.: Consulting: BrainLab.

    All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

    Additional information

    Martin Vazan and Yu-Mi Ryang contributed equally to this work.

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    Vazan, M., Ryang, YM., Gerhardt, J. et al. L5 corpectomy—the lumbosacral segmental geometry and clinical outcome—a consecutive series of 14 patients and review of the literature. Acta Neurochir 159, 1147–1152 (2017). https://doi.org/10.1007/s00701-017-3084-5

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    • DOI: https://doi.org/10.1007/s00701-017-3084-5

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