Vertebral body resection and lumbar corpectomies

Abstract

Corpectomies in the lumbar spine are unique operations with important and well-deserving nuances that determine their ultimate safety and efficacy. Lumbar vertebral resections are indicated in deformity and non-deformity settings. For deformities, they are reserved for those that are severe and rigid. Infections, fractures, and tumors that compromise the weight-bearing capacity of the anterior and middle columns of the spine are also indicated for lumbar vertebrectomy. Anterior column structural support is required in non-deformity situations and may be accomplished with the use of polymethyl methacrylate (PMMA) cement, osseous strut grafts (i.e. allografts/autograft), or titanium cages (static vs. expandable). The newest generation of cages have wide, rectangular footprints that span the apophyseal ring and provide a sound biomechanical environment and minimize the risk of cage subsidence compared to those with circular footprints. Neural decompression and placement of structural support can be accomplished by a variety of surgical approaches. While a traditional anterior approach is the gold-standard for lumbar vertebrectomies, minimally invasive lateral approaches and a posterior-only approach are viable management strategies. Supplemental fixation is also required and may be achieved with anterior-only instrumentation, posterior-only instrumentation, and circumferential instrumentation. In the review to follow, an evidence-based approach will be used to outline appropriate indications, surgical technique, and concomitant reconstructive and stabilization options for lumbar corpectomies. The discussion to follow ideally will help optimize outcomes for patients treated with vertebral resection and lumbar corpectomies in the lumbar spine.