Total En Bloc Spondylectomy for the Fifth Lumbar Solitary Metastasis by a Posterior-Only Approach

Li, Zhenfeng; Lv, Zhaorui; Li, Jianmin

doi:10.1016/j.wneu.2019.07.054

Cited by 5 publications

(3 citation statements)

References 20 publications

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“…We undertook TES and lumbosacral reconstruction via a combined posteroanterior approach in two different days, using the second surgery for both removing the primary tumor (by general surgeon through a laparotomy) and performing the anterior approach to the spine. The use of a posterior-only approach is technically challenging for L5 tumors, although Li et al 30 reported a case (62-year-old woman with breast cancer and a single lesion in the L5 vertebra) without severe complications. After that, Yang et al 31 also reported satisfactory results and good tumor control for a few L5 tumors using a posterior-only approach.…”

Section: Discussionmentioning

confidence: 99%

Total en bloc spondylectomy for the L5 metastasis of a carcinoid tumor: illustrative case

Jódar¹,

Caparrós²,

Marin³

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Total en bloc spondylectomy (TES) was designed to achieve oncological complete tumor resection in a vertebral compartment. Because of the special anatomy of the lumbosacral junction, TES procedure at the L5 level is a challenge, and it has been explained in few reports in the literature. Performing TES in the lower lumbar region, as normal, is accomplished by using a combined approach. OBSERVATIONS The authors presented the case of a 20-year-old man with an isolated spinal metastasis at the L5 level of carcinoid tumor of jejunum, limited to the vertebral body. Due to good long-term prognosis, after multidisciplinary evaluation the authors decided to treat the patient with TES through a combined posteroanterior approach, with posterior instrumentation and anterior reconstruction. Nine years after surgery, the patient was asymptomatic, with no sign of local recurrence. LESSONS TES is a feasible technique to provide long-term survival in a select subgroup of patients, reducing the risk of local recurrence. The authors presented some anatomical and biomechanical factors that must be considered at the lumbosacral region. Despite the high rates of complication associated with TES, most patients benefit from local control provided by the technique.

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Section: Discussionmentioning

confidence: 99%

Total en bloc spondylectomy for the L5 metastasis of a carcinoid tumor: illustrative case

Jódar¹,

Caparrós²,

Marin³

et al. 2022

Journal of Neurosurgery: Case Lessons

View full text Add to dashboard Cite

show abstract

“…4,6,18,19 However, at the lumbar level, especially at L3 to L5, the nerve root sacrificed can cause significant deterioration in ambulation and dependence on other people for normal ADL. 1,7,8,20 The L2 nerve root forms part of the lumbar plexus, which contributes to innervation of the IP and Qd muscles. 10,11 Sacrificing the bilateral L2 nerve root in spinal surgery raises the possibility of post-operative neurological deterioration of the IP and Qd muscles.…”

Section: Discussionmentioning

confidence: 99%

“…Total en bloc spondylectomy (TES) is considered one of the surgical options for primary spinal tumors and some patients with spinal metastasis. [1][2][3][4][5][6] As an aid to surgical dissection, bilateral nerve root ligation is performed at the thoracic spinal level. It is known that at the lumbar spinal level, L3 to L5 nerve root transection will result in residual deterioration of motor function of the quadriceps (Qd) and tibialis anterior, which will impair the ability to perform basic activities of daily living (ADL).…”

Section: Introductionmentioning

confidence: 99%

Safety and Neurologic Recovery of L2 Nerve Root Sacrificed in Total En Bloc Spondylectomy Involving the L2 Vertebra

et al. 2021

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Background: The L2 nerve root is considered part of the lumbar plexus that innervates the iliopsoas (IP) and quadricep muscles (Qd). Total en bloc spondylectomy (TES) at the L2 vertebra requires bilateral nerve root transection to facilitate surgical dissection and vertebral body removal. Information regarding neurological function recovery of the IP and Qd in patients with muscle weakness before TES is lacking. We aimed to report the neurological recovery of IP and Qd after TES involving the L2 vertebra in preoperative lower extremity weakness in spinal tumor patients.Methods: We prospectively recorded all L2-involved spinal tumor patients undergoing TES between January 2018 and November 2020. As a primary outcome, we recorded the Manual Muscle Testing (MMT) grade of the IP and Qd preoperatively, immediately postoperatively, and at follow-up. Secondary outcomes included the Frankel neurological status, sensation impairment, and the Eastern Cooperative Oncology Group score.Results: From 8 TES-involving L2 patients, 6 (4 males) met the inclusion criteria. One patient had first-grade deterioration of the Qd MMT immediately postoperatively. All patients could ambulate independently 6 months after surgery. Five patients required follow-up for more than 1 year and could walk without any gait aids. All patients had persistent anterior groin and bilateral thigh numbness until the final follow-up.Conclusion: Neurological recovery of the IP and Qd muscles as measured by MMT can occur within 6 months of bilateral L2 nerve root transection. Bilateral L2 nerve root sacrifice can have acceptable neurological outcomes and recovery, even in patients with preoperative IP and Qd weakness.Level of Evidence: 4.

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An improved total en bloc spondylectomy for L5 vertebral giant cell tumor through a single-stage posterior approach

Wan¹,

Zheng²,

Wan³

et al. 2023

Eur Spine J

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Total En Bloc Spondylectomy for the Fifth Lumbar Solitary Metastasis by a Posterior-Only Approach

Cited by 5 publications

References 20 publications

Total en bloc spondylectomy for the L5 metastasis of a carcinoid tumor: illustrative case

Total en bloc spondylectomy for the L5 metastasis of a carcinoid tumor: illustrative case

Safety and Neurologic Recovery of L2 Nerve Root Sacrificed in Total En Bloc Spondylectomy Involving the L2 Vertebra

An improved total en bloc spondylectomy for L5 vertebral giant cell tumor through a single-stage posterior approach

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