title: L5 corpectomy-the lumbosacral segmental geometry and clinical outcome-a consecutive series of 14 patients and review of the literature.
abstract: We analyzed the lumbosacral segmental geometry and clinical outcome in patients undergoing L5 corpectomy.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany. martin.vazan@gmail.com.|Zentrum für Wirbelsäulentherapie, Städtisches Klinikum Dresden, Dresden, Germany. martin.vazan@gmail.com.
authors.forename: Martin
authors.identifier: 0000-0003-3245-1941
authors.initials: M
authors.lastname: Vazan
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: Yu-Mi
authors.initials: YM
authors.lastname: Ryang
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Gerhardt
authors.affiliation: Department of Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Zibold
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: Insa
authors.initials: I
authors.lastname: Janssen
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.|Neurosurgical Center, Medical University of Mainz, Mainz, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Ringel
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Gempt
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008141:Lordosis / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed
keywords: Anterior lumbar fusion; L5 corpectomy; Lumbosacral junction; Sagittal balance