Direct Midline Posterior Corpectomy and Fusion of a Lumbar Burst Fracture with Retrospondyloptosis: A Case Report.

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Direct Midline Posterior Corpectomy and Fusion of a Lumbar Burst Fracture with Retrospondyloptosis: A Case Report.

World Neurosurg. 2017 Jan 09;:

Authors: Carminucci A, Assina R, Hernandez RN, Goldstein IM

Abstract
BACKGROUND: Traumatic burst fractures of the lumbar spine can result in significant neurological injury and mechanical instability. The ideal surgical approach for the treatment of unstable lumbar spine burst fractures remains debatable.
CASE DESCRIPTION: A 37 year-old male presented with severe neurological injury including loss of motor function below the level of the iliopsoas muscles bilaterally, saddle anesthesia, and absent rectal tone, following a fall from 60 ft. CT scan revealed an L4 vertebral body comminuted burst fracture with complete posterior translation of L4 over L5. Patient was taken to the operating room for an L4 corpectomy and L2-S1 posterior fusion. The L4 vertebral body was visualized posterior to the posterior elements of L5 and resected in a piecemeal fashion. Since the thecal sac had been completely transected, a visible path down the L3-L4 and L4-L5 disk spaces was apparent allowing direct posterior discectomies at these levels, and completion of the L4 segment resection. The use of a direct posterior approach resulted in minimal blood loss, correction of sagittal alignment, and satisfactory outcomes comparable to the standard posterior transpedicular approach. Construct stability and solid boney fusion have been maintained through 4 years postoperatively.
CONCLUSION: The use of a direct midline posterior corpectomy approach may be considered for patients with lumbar burst fractures, high grade neurological injury, and transection of the thecal sac.

PMID: 28089837 [PubMed - as supplied by publisher]

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