Corpectomy of the fifth lumbar vertebra, a challenging procedure

Study Design: A retrospective study of 25 consecutive cases undergoing L5 corpectomy and reconstruction. Summary of Background Data: Corpectomy of L5 is a challenging procedure because of the unique biomechanical and anatomic properties of this level. OBJECTIVE: To report the clinical and radiographic outcomes and to stress the technical difficulties encountered with L5 corpectomy, reconstruction of the resulting defect together with posterior stabilization. METHODS: Between 2003 and 2008 25 consecutive cases (13 females and 12 males, mean age 54.5 y) underwent L5 corpectomy, followed by titanium cage implantation and posterior stabilization. The indications for surgery were fracture (44%), bony destruction by tumor (44%), and spondylodiscitis (12%). Results: The mean amount of intraoperative blood loss was 3.4 L. The cage was implanted through a posterior approach in a single patient with lymphoma. In the remaining 24 patients, an expandable cage was implanted through a ventral approach. Intraoperative complications occurred in 2 patients presenting with fracture. This was in the form of injury to the left common iliac vein in one patient and extensive epidural bleeding reaching 10 L in the other patient. Five patients died within 2 years after surgery: 2 of them were presenting with spondylodiscitis and died later due to sepsis, whereas the remaining 3 patients had advanced malignancy. In the remaining 20 patients, the mean follow-up period was 3.4 years. Local recurrence of infection occurred in 1 patient necessitating change of the cage. Recurrence of metastasis occurred in 2 patients; one of them underwent posterior decompression and the other one was treated successfully with local irradiation. CONCLUSIONS: L5 corpectomy is a demanding procedure because of the vascular anatomy at that level. Large amount of blood loss should be expected. In case of complication or recurrence of the pathology, revision surgery is more demanding and necessitates a wide experience. © 2013 by Lippincott Williams & Wilkins.