Surgical approaches to L5 corpectomy: a systematic review
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REVIEW ARTICLE
Surgical approaches to L5 corpectomy: a systematic review Daniel D’Aquino1 · Ahmad M. Tarawneh1 · Aaron Hilis1 · Nigil Palliyil1 · Kedar Deogaonkar1 · Nasir A. Quraishi1 Received: 15 May 2020 / Revised: 13 September 2020 / Accepted: 26 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Surgical approaches to pathologies of the L5 vertebra constitute a significant challenge. Our aim was to review the efficacy and safety of the surgical approaches to L5 corpectomy and reconstruction across the range of presenting pathology. Materials and methods This systematic review was conducted according to PRISMA guidelines, and databases were searched from 1970 to January 2020. The search inclusion criteria were L5 Corpectomy AND/OR Spondylectomy AND/OR Vertebrectomy. The outcome measures studied were length of surgery, blood loss, fusion or failure of fusion/instrumentation, complications and mortality. Results Initial 36 articles were identified, and final 6 studies met our inclusion criteria. The mean reported blood loss was 2265 ml (400–4700 ml) and was higher for the two-stage posterior–anterior surgery group than the posterior-only surgery group (mean 3230 mls vs. 1260 mls) but not the operative time. All surgical approaches shared high fusion rates (94%) and relatively low complication rates (11.7%). However, surgical strategies incorporating an anterior approach were notable for vascular complications (4–7%), as well as perioperative mortality (9%) not seen in the posterior-only surgery group. Conclusion Where there is clinical and circumstantial equipoise regarding the choice of surgical approaches for a L5 corpectomy, this review indicates a reported mean blood loss of 2265 ml (400—4700 ml), high fusion rates (94%) and relatively low complication rates (11.7%). It is difficult to make direct comparisons between approaches due to small case series, the variability in primary pathology, clinical intent and surgeon experience. Keywords L5 corpectomy · Spondylectomy · Vertebrectomy
Introduction Surgical approaches to pathologies of the L5 vertebra constitute a significant challenge on account of the anatomical features of the lumbosacral junction. The biomechanics of the lumbosacral junction—characterised by a sloping transition from a dynamic lower lumbar region to a relatively motionless sacrum and pelvis—exerts high levels of stress on surgical constructs at this level on account of the combination of sliding as well as compressive forces [1–3]. Furthermore, the intimate relationship of the lumbosacral junction to the great vessels in the retroperitoneal compartment compounds surgical risk further with the added threat of * Ahmad M. Tarawneh [email protected] 1
Centre for Spinal Studies and Surgery, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
significant vascular injury. The reported total complication rate for vascular injuries in anterior spine surgery ranges from 7.9 to 13.8% [4]. Destructive p
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