title: Vertebrectomy and expandable cage placement via a one-stage, one-position anterolateral retroperitoneal approach in L5 tumors.
abstract: Spinal reconstruction of the L5 vertebrae after tumor resection remains a challenge. Complex resection followed by circumferential fixation in the same setting, or in staged fashion, is often employed. The added operative time associated with this method potentially increases morbidity and mortality in an inherently high-risk procedure and anatomy in the lumbosacral area makes reconstruction more challenging. The authors describe a technique involving L5 vertebrectomy, placement of an expandable cage, and anterolateral L4-S1 screw fixation via a one-stage, one-position, anterolateral retroperitoneal approach. Two illustrative cases are presented along with the authors overall experience in L5 tumor operations. We believe that this is a feasible reconstructive option after tumor resection in lower lumbar metastatic spine disease. The approach may be also utilized in combined anteroposterior (two-stage) procedures in primary malignant tumors or oligometastatic disease.
authors.affiliation: Department of Neuro-Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida 33647, USA.
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Papanastassiou
authors.forename: Surbhi
authors.initials: S
authors.lastname: Jain
authors.forename: Ali A
authors.initials: AA
authors.lastname: Baaj
authors.forename: Mohammed
authors.initials: M
authors.lastname: Eleraky
authors.forename: Panayotis J
authors.initials: PJ
authors.lastname: Papagelopoulos
authors.forename: Frank D
authors.initials: FD
authors.lastname: Vrionis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation*; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*; D016896:Treatment Outcome