title: Lumbosacral junction fixation and fusion after complete L-5 spondylectomy. Case report.
abstract: The goals of surgery for metastatic disease of the lumbosacral spine are to relieve compression of the thecal sac and nerve roots, to resect malignant tissue, and to create a stable reconstruction of the spine. Reconstruction of the lumbosacral junction, specifically the L-5 vertebral body, is particularly challenging because the biomechanical properties of this level differ from other areas of the spine. A 40-year-old woman with intraductal breast carcinoma that metastasized to the L-5 vertebral body presented with progressive low-back pain, right-sided L-5 radiculopathy, and weakness. Magnetic resonance imaging revealed a pathological fracture of the L-5 vertebral body with compression of the cauda equina. The L-5 posterior arch, both facet joints and pedicles, and the posterior third of the vertebral body were removed via a posterior approach. A pedicle screw fixation system was applied from L-4 to S-1. The patient was repositioned, and a transabdominal approach was used to resect the anterior two thirds of the L-5 body, which was reconstructed using an allograft bone strut. An interference bone screw was placed through the inferior aspect of the allograft and screwed into the body of S-1 to provide stability for the reconstructive graft. The patient's clinical recovery was excellent. She was ambulating without difficulty when seen at 19-month follow-up examination. Complete spondylectomy by using this novel fusion technique was efficacious in the treatment of metastatic disease to the vertebral column.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: P W
authors.initials: PW
authors.lastname: Detwiler
authors.forename: R W
authors.initials: RW
authors.lastname: Porter
authors.forename: N R
authors.initials: NR
authors.lastname: Crawford
authors.forename: P J
authors.initials: PJ
authors.lastname: Apostolides
authors.forename: C A
authors.initials: CA
authors.lastname: Dickman