Lumbar spondylectomy.
It is unknown if spinal instrumentation is required to prevent deformity after partial vertebrectomy in the treatment of primary bronchogenic carcinomas invading the spine (PBCIS).
There are no validated criteria to justify a systematic spinal instrumentation when performing a partial vertebrectomy during en bloc resection of PBCIS. Performed alone without spine instrumentation, both type A and type B resections on less than three resected vertebrae were not subject to sagittal and coronal deformity even after a long follow-up, emphasizing that a systematic stabilization is not needed in this low-risk group. These results could help to reduce the perioperative morbidity of these procedures that are usually long and complex 1).
A vertebrectomy is indicated for lesions in zones 4-8, or 5-9 of the Weinstein Boriani Biagini classification with at least one pedicle free of tumour. This allows for a combined posterior approach, with the posterior elements removed in a piece-meal fashion. The unaffected pedicle allows for resection on the posterior aspect of the vertebral body, with the subsequent establishment of haemostatic control, as well as freeing of the posterior longitudinal ligament. A second anterior approach is then utilised to remove the vertebral body containing the tumour in its entirety (en-bloc) 2).
Modified approach for piecemeal lumbar vertebrectomy through a bilateral transpedicular approach followed by double cage reconstruction and short segment fusion. This technique affords several advantages, the most obvious of which is that it allowed the use of a significantly smaller midline incision (6 cm). This smaller exposure did not compromise our ability to perform a vertebrectomy 3)
A case of undetected traumatic double-level spondyloptosis in the upper thoracic region in an adult male patient who was neurologically intact for 2 days but later became paraplegic. Initially, management of this pathology seemed a very challenging scenario. However, with review of the reconstructed CT images and reproduction of the injury on a plastic model, a posterior-only approach was chosen as an alternative operative solution for this catastrophic injury. Via this single-stage posterior approach, long-segment pedicle screw/rod instrumentation resulted in successful reduction, restoration of alignment, and stabilization after 1-level posterior spondylectomy. To the best of the authors' knowledge, this is the first example reported in the literature of double-level spondyloptosis of the thoracic and the lumbar spine. This report describes the rationale, mechanism, and technical details afforded for reduction and stabilization of this rare injury 4).