title: Total L-5 spondylectomy and reconstruction of the lumbosacral junction. Technical note.
abstract: The authors describe a technique for total L-5 spondylectomy and reconstruction of the lumbosacral junction. The technique, which involves separately staged posterior and anterior procedures, is reported in two patients harboring neoplasms that involved the L-5 level. The first stage consisted of a posterior approach with removal of all posterior bone elements of L-5 and radical L4-5 and L5-S 1 discectomies. Lumbosacral and lumbopelvic instrumentation included pedicle screws as well as iliac screws or a transiliac rod. The second stage consisted of an anterior approach with mobilization of vascular structures, completion of L4-5 and L5-S1 discectomies, and removal of the L-5 vertebral body. Anterior lumbosacral reconstruction included placement of a distractable cage and tension band between L-4 and S-1. Allograft bone was used for fusion in both stages. No significant complications were encountered. At more than 1 year of follow-up, both patients were independently ambulatory, without evidence of recurrent or metastatic disease, and adequate lumbosacral alignment was maintained. The authors conclude that this technique can be safely performed in appropriately selected patients with neoplasms involving L-5.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. ggallia1@jhmi.edu
authors.forename: Gary L
authors.initials: GL
authors.lastname: Gallia
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.forename: Ian
authors.initials: I
authors.lastname: Suk
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
mesh_terms: D000328:Adult; D001858:Bone Nails; D001863:Bone Screws; D016025:Bone Transplantation; D017586:Diskectomy; D005260:Female; D005500:Follow-Up Studies; D005870:Giant Cell Tumors / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000601:surgery; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D011184:Postoperative Period; D011859:Radiography; D012447:Sacrum / Q000601:surgery*; D012509:Sarcoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous; D016138:Walking