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Anterior Lumbar and Lumbosacral Approach: Transperitoneal

  • Cecilia L. Dalle Ore
  • Darryl Lau
  • Christopher Pearson AmesEmail author
Chapter

Abstract

En bloc resection of specific spine lesions is associated with decreased local recurrence, improved health-related quality of life (HRQoL), and increased survival. Three main approaches exist for en bloc resection of spinal lesions: vertebrectomy, sagittal resection, and resection of the posterior elements. Of these, posterior vertebrectomy is often the preferred approach for centrally located lesions of the vertebral body. However, very large lesions of the vertebral body, lesions with significant anterior paravertebral extension, or lesions impinging upon major blood vessels may require an anterior/transperitoneal approach. The anterior approach allows for direct visualization of the vertebral body and surrounding structures such as the great vessels. A transperitoneal approach may be combined with posterior instrumentation in a multistage procedure. Large lesions of the vertebral body can be successfully resected en bloc using an anterior or combined anterior/posterior approach.

Keywords

En bloc spondylectomy Vertebrectomy Transperitoneal Lumbar Sacral Primary spinal tumor Spinal metastases 

Supplementary material

Video 11.1

Intraoperative video illustrating isolation of the inferior vena cava within the abdominal cavity. In this video clip, the lymphatics are being dissected from the surface of the inferior vena cava to allow for isolation and mobilization of the vessel (MP4 49638 kb)

Video 11.2

Intraperitoneal exposure of the tumor. The inferior vena cava is evidently superior and medial to the tumor, which is within the psoas muscle and the L2 vertebral body within the retroperitoneal space (MP4 70706 kb)

Video 11.3

En bloc removal of the tumor. This video clip shows the completion of discectomies above and below L2 and the division of the psoas above and below the lesion. The lesion and the L2 vertebral body are rolled out en bloc from beneath the inferior vena cava (MP4 10516 kb)

Video 11.4

Anatomy following en bloc resection. This narrated clip identifies the inferior vena cava, aorta, renal vessels, and the resultant cavity following en bloc spondylectomy (MP4 65447 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Cecilia L. Dalle Ore
    • 1
  • Darryl Lau
    • 1
  • Christopher Pearson Ames
    • 1
    Email author
  1. 1.Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoUSA

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