Anterior-only instrumentation and grafting after L5 corpectomy for non-traumatic lesions

Anterior decompression and reconstruction have been used for the treatment of various conditions at the lumbosacral junction, particularly those necessitating corpectomy because of destruction due to primary or secondary bone tumour or infection. The authors conducted a prospective study on 15 consecutive patients who underwent L5 (L4-L5 in 3 cases) corpectomy for tumour or infection, between 2000 and 2005: 6 for tumour, 7 for tuberculous spondylitis, and 2 for pyogenic spondylitis. Corpectomy, bonegrafting (tricortical iliac bone graft or titanium mesh-bone graft) and anterior-only instrumentation (screw-plate or screw-rod) were performed via a retroperitoneal approach. One month of bed rest yielded additional stability. The patients were followed up for an average of 39.7 months (range: 7-73 months). Pain relief and neurological recovery were excellent. Solid fusion was obtained in all patients. There were no cases of plate or screw failure. Three patients with metastases died after 7, 17, and 13 months, in spite of successful fusion. No recurrence was noted in all 9 patients with spinal infection. The results observed indicate that grafting and anterior-only instrumentation and grafting is an effective and safe procedure for reconstruction of the lumbosacral junction following L5 (or even L4-L5) corpectomy; it may obviate the need for additional posterior stabilization in selected patients.