Lumbar Corpectomy

John A. Rodriguez-Feo

Andrew H. Milby

S. Tim Yoon

Illustrative Case

A 50-year-old male fell from a roof sustaining isolated spine fractures consisting of an L3 burst fracture with severe canal compromise as well as a T12 compression fracture. He presented with urinary retention as well as bilateral lower extremity numbness and tingling with hip flexion and knee extension weakness (Figures 26-1 and 26-2).

Figure 26-1 ▪ Sagittal computed tomography scan views of the spine (A, B, C). L3 burst fracture with significant canal intrusion with bony fragments is seen. There is also a coronal split in the vertebral body of L3. T12 compression fracture is also noted.

Figure 26-2 ▪ Axial computed tomography scan through vertebral body of L3 pedicle (A) shows the severe canal intrusion and coronal fracture of the vertebral body. Bilateral facet joint gapping at L3-4 is noted (B). Magnetic resonance imaging shows vertebral body fracture on axial view (C). There is severe spinal canal stenosis because of the retropulsed bony fragment as seen on the sagittal view (D).

Positioning

Lateral position—back parallel to bed with greater trochanter at hinge/break in bed. Hips and knees flexed, axillary roll, peroneal nerve, and bony prominences padded.
Tape patient to make sure that he or she is secure and will remain in correct position without the chance of moving during the procedure. We accomplish this by circumferential taping twice around the patient and bed at the level between the trochanter and iliac crest as well as at the chest, usually nipple level. Make sure to tape patient while keeping the spine orthogonal to the floor.
Slight break in bed in order to open the space between the iliac crest and the ribs.
Use C-arm to verify that the spine is orthogonal to the floor and rotate/tilt the bed to fine-tune as necessary (Figure 26-3).

Figure 26-3 ▪ Artist’s rendition of the patient in the lateral decubitus position. All the pressure points are well padded and the body is secured with tape and/or belt. The proposed oblique incision is shown.

Anesthesia/Neuromonitoring Concerns

Large-bore intravenous access in the setting of open retroperitoneal approach.
No paralytics in neuromonitoring is desired.

Localization of Incision

Use a radiopaque object to determine the location of the incision, which will be centered over the site of the corpectomy. This is orientated obliquely.
Breaking the bed can help move the rib cage out of the way but for upper lumbar corpectomies, a rib or partial rib must often be removed.

Approach