Minimally Invasive L5 Corpectomy with Navigated Expandable Vertebral Cage: A Technical Note

Abstract

Background: Conventional L5 corpectomy requires a large incision and an extended period of intraoperative fluoroscopy. We describe herein a new L5 corpectomy technique. Methods: A 79-year-old woman was referred to our hospital for leg pain and lower back pain due to an L5 vertebral fracture. Her daily life had been affected by severe lower back pain and sciatica for more than 2 months. We initially performed simple decompression surgery, but this proved effective for only 10 months. Results: For revision surgery, the patient underwent minimally invasive L5 corpectomy with a navigated expandable cage without fluoroscopy. The second surgery took 215 min, and estimated blood loss was 750 milliliters. The revision surgery proved successful, and the patient could then walk using a cane. In terms of clinical outcomes, the Oswestry Disability Index improved from 66% to 24%, and the visual analog scale score for lower back pain improved from 84 to 31 mm at the 1-year follow-up. Conclusions: Minimally invasive L5 corpectomy with a navigated expandable vertebral cage is effective for reducing cage misplacement and surgical invasiveness. With this new technique, surgeons and operating room staff can avoid the risk of adverse events due to intraoperative radiation exposure.

Comparison of Navigated Expandable Vertebral Cage with Conventional Expandable Vertebral Cage for Minimally Invasive Lumbar/Thoracolumbar Corpectomy

“…In radiographic evaluation in our data, lateral cage position and cage sinking in group N were statistically significant results compared with those in group C. Accurate cage placement is technically difficult at lower lumbar levels due to lordotic space [ 3 ]. It is challenging to put expandable cages in optimum positions in non-parallel gaps after corpectomy.…”

“…Stable TLBF, such as a kyphotic angle less than 30-40 degrees and spinal canal narrowing less than 50–60% [ 14 , 15 ], without neurologic deficit, can be treated non-operatively with acceptable functional and radiographic results [ 4 , 5 , 16 , 17 ]. Unstable and TLBF with neurologic involvement needs surgical intervention [ 3 , 18 ]. Selection of surgical approach (anterior, posterior, or combined) depends upon various factors including position of fragment, bone density, comorbidity, availability of resources, and surgeon experience [ 18 ].…”

“…Use of navigated expandable cage after thoracolumbar corpectomy was reported in only two case reports. T12 corpectomy in an 82-year-old female after failed BKP showed significant improvement in ODI (62% to 22%) and VAS (80 mm to 33 mm), and L5 corpectomy in 79-year-old female yielded good improvement in ODI (66% to 24%) and VAS (84 to 31 mm) at one-year follow-up [ 3 , 10 ].…”

“…TLBF is one of the most common injuries, representing approximately 15% of all thoracolumbar fractures and causing neurological impairment in one fourth of them [ 2 ]. For elderly patients, this type of fracture is caused by osteoporotic vertebral fracture (OVF) [ 3 ]. Conservative treatment can be tried if the TLBF is an incomplete burst (AO type A3) or a complete burst (AO type 4) without neurological deficit [ 4 ], because it has benefits such as fewer complications [ 5 ].…”

“…Currently, minimally invasive (MI) corpectomy is available thanks to spinal surgical technology. A main disadvantage of conventional MI corpectomy is the misplacement of vertebral cages and the need for extended use of intraoperative fluoroscopy [ 3 ]. To solve these problems, the authors reported a novel technique of MI corpectomy under navigation guidance [ 10 ].…”