Imaging and biomechanics researches of reconstructing lumbosacral stability after L<sub>5</sub> vertebrectomy via anterolateral approach _Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUNZhaozhong ¹ ,  CHENGYan ² , LIRui ¹ , RENJiabin ¹ , FANGQingmin ¹ , ZHENGZhenyang ¹ , LIUXin ¹

1. Department of Spine Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou Shandong, 256610, P.R.China;
2. Department of Neurology, Binzhou People’s Hospital, Binzhou Shandong, 256610, P.R.China;

Corresponding author：

CHENGYan, Email: chy9062@163.com

Keywords：

L₅ lesions; anterolateral approach; imaging; biomechanics

DOI：

10.7507/1002-1892.201610092

Video：

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Objective To investigate the feasibility of anterolateral approach for L₅ vertebral resection, bone grafting, and screw rod fixation by imaging and biomechanics researches. Methods Twenty formalized adult cadavers (12 males and 8 females) were randomly divided into 2 groups; L₅ vertebral resection, bone graft, and screw rod fixation was performed on 10 specimens by using anterolateral approach (experimental group), and on the other 10 specimens by combined anterior and posterior approach. CT scanning and three-dimensional reconstruction were performed in the experimental group; preoperative maximal safe entry angle and depth of screws and intraoperative actual entry angle and depth of screws were measured; the sacral screw position was observed after operation. The biomechanical test was done in 2 groups. Results Twenty specimens smoothly underwent L₅ excision and reconstruction. CT scan showed that there was no significant difference in maximal safe entry angle and depth of screws between males and females in experimental group before operation (P>0.05); the maximal safe entry angle and depth were 51.93° and 47.88 mm for anterior screw, and were 37.04° and 46.28 mm for posterior screw. After operation, depth of the sacral anterior and posterior screws were appropriate, which did not pierce into the spinal canal. The biomechanical test results indicated that the flexion, extension, and lateral flexion displacements, and vertical compression stiffness showed no significant difference between 2 groups (P>0.05). Conclusion For L₅ lesions not invading posterior column, to use L₅ vertebral resection, bone graft, and screw rod fixation by anterolateral approach is a safe and feasible method to reconstruct lumbosacral stability, with the advantages of no changing posture, less operation time and incision, and prevention of bone graft shift, but effectiveness need further be identified.

Citation： SUNZhaozhong, CHENGYan, LIRui, RENJiabin, FANGQingmin, ZHENGZhenyang, LIUXin. Imaging and biomechanics researches of reconstructing lumbosacral stability after L₅ vertebrectomy via anterolateral approach . Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(2): 210-214. doi: 10.7507/1002-1892.201610092 Copy

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9.	王世勇, 张涛, 蓝旭, 等. 前外侧腹膜外入路一期病灶清除植骨内固定治疗腰骶段结核临床观察. 疑难病杂志, 2015, 14(2): 164-167.
10.	Bianchi C, Ballard JL, Abou-Zamzam AM,et al. Anterior retroperitoneal lumbosacral spine exposure: operative technique and results. Ann Vasc Surg, 2003, 17(2): 137-142.
11.	Gerber M, Craeford NR, Chanberlain RH,et al. Biomechanical assessment of anterior lumbar interbody fusion with an anterior lumbosacral fixation screw-plate: comparison to stand-alone anterior lumbar interbody fusion and anterior lumbar interbody fusion with pedicle screws in an unstable human cadaver model. Spine (Phila Pa 1976), 2006, 31(7): 762-768.
12.	Wood KB, Devine J, Fischer DV,et al. Vascular injury in elective anterior lumbosacral surgery. Spine (Phila Pa 1976), 2010, 35(9 Suppl): 66-75.
13.	Papanastassiou ID, Jain S, Baaj AA,et al. Vertebrectomy and expandable cage placement via a one-stage, one-position anterolateral retroperitoneal approach in L₅ tumors. J Surg Oncol, 2011, 104(5): 552-558.
14.	沈凯, 谭祖健. 几种常见腰椎融合术的比较. 中国骨与关节损伤杂志, 2011, 26(11): 1054-1056.
15.	Shen FH, Marks I, Shaffrey C,et al. The use of an expandable cage for corpectomy reconstruction of vertebral body tumors through a posterior extracavitary approach: a multicenter consecutive case series of prospectively followed patients. Spine J, 2008, 8(2): 329-339.
16.	Vaccaro AR, Lim MR, Hurlbert RJ,et al. Surgical decision making for unstable thoracolumbar spine injuries: results of a consensus panel review by the Spine Trauma Study Group J Spinal Disord Tech, 2006, 19(1): 1-10.

1. Moon MS, Moon YW, Moon JL,et al. Conservative treatment of tuberculosis of the lumbar and lumbosacral spine. Clin Orthop Relat Res, 2002, (398): 40-49.
2. Salame K, Regev G, Keynan O,et al. Total en bloc spondylectomy for vertebral tumors. Isr Med Assoc J, 2015, 17(1): 37-41.
3. 蓝旭, 许建中, 刘雪梅, 等. 前后联合入路病灶清除植骨融合内固定治疗腰骶椎结核. 中国修复重建外科杂志, 2011,25 (10): 1176-1179.
4. 兰家平, 汤逊, 徐永清, 等. 前路一期病灶清除植骨联合自锁钛板内固定治疗腰骶段结核. 中国修复重建外科杂志, 2016, 30(5): 585-589.
5. Wang X, Pang X, Wu P,et al. One-stage anterior debridement, bone grafting and posterior instrumentation vs. single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis. Eur Spine J, 2014, 23(4): 830-837.
6. Voor MJ, Mehta S, Wang M,et al. Biomechanical evaluation of posterior and anterior lumbar interbody fusion techniques. J Spinal Disord, 1998, 11(4): 328-334.
7. Gallia GL, Sciubba DM, Bydon A,et al. Total L-5 spondylectomy and reconstruction of the lumbosacral junction. J Neurosurg Spine, 2007, 7(1): 103-111.
8. 贺茂林, 肖增明, 李世德, 等. 侧前方入路一期病灶清除植骨内固定治疗腰骶段结核. 中国脊柱脊髓杂志, 2009, 19(11): 818-822.
9. 王世勇, 张涛, 蓝旭, 等. 前外侧腹膜外入路一期病灶清除植骨内固定治疗腰骶段结核临床观察. 疑难病杂志, 2015, 14(2): 164-167.
10. Bianchi C, Ballard JL, Abou-Zamzam AM,et al. Anterior retroperitoneal lumbosacral spine exposure: operative technique and results. Ann Vasc Surg, 2003, 17(2): 137-142.
11. Gerber M, Craeford NR, Chanberlain RH,et al. Biomechanical assessment of anterior lumbar interbody fusion with an anterior lumbosacral fixation screw-plate: comparison to stand-alone anterior lumbar interbody fusion and anterior lumbar interbody fusion with pedicle screws in an unstable human cadaver model. Spine (Phila Pa 1976), 2006, 31(7): 762-768.
12. Wood KB, Devine J, Fischer DV,et al. Vascular injury in elective anterior lumbosacral surgery. Spine (Phila Pa 1976), 2010, 35(9 Suppl): 66-75.
13. Papanastassiou ID, Jain S, Baaj AA,et al. Vertebrectomy and expandable cage placement via a one-stage, one-position anterolateral retroperitoneal approach in L₅ tumors. J Surg Oncol, 2011, 104(5): 552-558.
14. 沈凯, 谭祖健. 几种常见腰椎融合术的比较. 中国骨与关节损伤杂志, 2011, 26(11): 1054-1056.
15. Shen FH, Marks I, Shaffrey C,et al. The use of an expandable cage for corpectomy reconstruction of vertebral body tumors through a posterior extracavitary approach: a multicenter consecutive case series of prospectively followed patients. Spine J, 2008, 8(2): 329-339.
16. Vaccaro AR, Lim MR, Hurlbert RJ,et al. Surgical decision making for unstable thoracolumbar spine injuries: results of a consensus panel review by the Spine Trauma Study Group J Spinal Disord Tech, 2006, 19(1): 1-10.

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Imaging and biomechanics researches of reconstructing lumbosacral stability after L₅ vertebrectomy via anterolateral approach

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Imaging and biomechanics researches of reconstructing lumbosacral stability after L5 vertebrectomy via anterolateral approach

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Imaging and biomechanics researches of reconstructing lumbosacral stability after L₅ vertebrectomy via anterolateral approach