Emergency (Ad Hoc) Stabilization of The Anterior Vertebral Column with Two Combined Synex Implants After Two-Level Vertebrectomy L2 and L3. Case Report and the Technique Description

Abstract

Case report of the patient who underwent two-stage surgical treatment due to pathological fracture of vertebral column (L3 due neoplasm infiltration) in the course of kidney cancer is presented. Decompression of vertebral canal from the posterior approach in lumbar segment (L3 and partially L2) was performed due to sudden neurological functions impairment. Lumbar segment of vertebral column was stabilized via the transpedicular approach with Clix system (Synthes). In the second stage anterior approach via laparotomy was performed, urological team excised the kidney tumour, the next team vascular surgeon and neurosurgeon, performed resection of L3 and L2 vertebras (L3 was pathological fractured and compressed of cauda equine structures, L2 was partially cancer infiltrated). During the attempt of anterior column stabilization it was found, that the longest vertebral prosthesis of Synex set (Synthes) is shorter than the distance measured between L1 and L4 vertebras for about 5-7 mm. The anterior column stabilizing set consisting of two vertebral prostheses from Synex set connected permanently with the crosspieces – crossbars rods used in transpedicular stabilizations was constructed ad hoc using the available elements. Stable set ready to use was obtained. After preparation, the set was placed between the vertebral bodies, than extended .Control X -ray revealed its appropriate location and supporting function. The ad hoc formed set of such type could be only used in normal transpedicular posterior stabilization of the vertebral column, Distance between the vertebral bodies after the resection probably resulted from the constitutional patient traits (app. 200cm tall) The patient was assessed in Out Patient Clinic, his life was improved after the operation, was independently, Lovett score 4/ 5. After the operation was performed four courses of chemotherapy during 18 months.