Multilevel L4 and L5 Corpectomy for Burst Fracture via an Anterior Transperitoneal Approach Followed by Posterior Stabilization: Technical and Anatomic Considerations.

Kelly Gassie,Sukhwinder Johnny S Sandhu,Young Erben,Gian P Carames,Susana Fortich,Kingsley Abode-Iyamah

doi:10.7759/cureus.18579

Kelly Gassie, Sukhwinder Johnny S Sandhu + Show 4 more

Open Access

https://doi.org/10.7759/cureus.18579

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Abstract

Lower lumbar spine burst fractures make up only 1% of all lumbar spine fractures. A burst fracture with neurological compromise, ligamentous injury, severe kyphotic deformity, or loss of anterior column support typically requires surgical stabilization. Treatment options at the L4 and L5 levels are challenging and often require an anterior/posterior approach. Very little has been reported on anterior approaches to the L4 and L5 levels when a corpectomy is required. Hence, we present a patient with a complex burst fracture of L4 and L5. She underwent a corpectomy of L4 and L5 and placement of an expandable cage through a window created between the aorta and the inferior vena cava via an anterior transperitoneal abdominal approach followed by posterior stabilization and fusion from L2 to the pelvis.

Highlights

Lower lumbar spine burst fractures (L4 and L5) make up only about 1% of all lumbar spine fractures [1,2]
Very little has been reported on anterior approaches to the L4 and L5 levels when a corpectomy is required
She underwent a corpectomy of L4 and L5 and placement of an expandable cage through a window created between the aorta and the inferior vena cava via an anterior transperitoneal abdominal approach followed by posterior stabilization and fusion from L2 to the pelvis

Summary

Introduction

Lower lumbar spine burst fractures (L4 and L5) make up only about 1% of all lumbar spine fractures [1,2]. We report a patient with a severe burst fracture of the L4 vertebral body with associated severe L4-5 spinal canal stenosis that was surgically managed with a corpectomy of L4 and L5 through an anterior abdominal exposure followed by posterior stabilization. A posterior-only approach for stabilization was not feasible because of her prior L3-L5 laminectomies We believe this is one of the first reports of a multilevel lumbar spine corpectomy for a burst fracture through an anterior approach traversing the dangerous corridor of vessels including the inferior vena cava, iliac veins, aorta, and the aortic bifurcation. The patient had a two-month follow-up visit and she was progressing well recovering from her operations

Discussion

Conclusions

Disclosures

Lehman GJ

Findings

Denis F