The goals of surgery for metastatic disease of the lumbosacral spine are to relieve compression of the thecal sac and nerve roots, to resect malignant tissue, and to create a stable reconstruction of the spine. Reconstruction of the lumbosacral junction, specifically the L-5 vertebral body, is particularly challenging because the biomechanical properties of this level differ from other areas of the spine.
A 40-year-old woman with intraductal breast carcinoma that metastasized to the L-5 vertebral body presented with progressive low-back pain, right-sided L-5 radiculopathy, and weakness. Magnetic resonance imaging revealed a pathological fracture of the L-5 vertebral body with compression of the cauda equina. The L-5 posterior arch, both facet joints and pedicles, and the posterior third of the vertebral body were removed via a posterior approach. A pedicle screw fixation system was applied from L-4 to S-1. The patient was repositioned, and a transabdominal approach was used to resect the anterior two thirds of the L-5 body, which was reconstructed using an allograft bone strut. An interference bone screw was placed through the inferior aspect of the allograft and screwed into the body of S-1 to provide stability for the reconstructive graft.
The patient's clinical recovery was excellent. She was ambulating without difficulty when seen at 19-month follow-up examination.
Complete spondylectomy by using this novel fusion technique was efficacious in the treatment of metastatic disease to the vertebral column.