Multilevel L4 and L5 Corpectomy for Burst Fracture via an Anterior Transperitoneal Approach Followed by Posterior Stabilization: Technical and Anatomic Considerations

November 12, 2021

Case Reports

. 2021 Oct 7;13(10):e18579.

doi: 10.7759/cureus.18579.

eCollection 2021 Oct.

Affiliations

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Case Reports

Kelly Gassie et al.

Cureus.

2021.

Abstract

Lower lumbar spine burst fractures make up only 1% of all lumbar spine fractures. A burst fracture with neurological compromise, ligamentous injury, severe kyphotic deformity, or loss of anterior column support typically requires surgical stabilization. Treatment options at the L4 and L5 levels are challenging and often require an anterior/posterior approach. Very little has been reported on anterior approaches to the L4 and L5 levels when a corpectomy is required. Hence, we present a patient with a complex burst fracture of L4 and L5. She underwent a corpectomy of L4 and L5 and placement of an expandable cage through a window created between the aorta and the inferior vena cava via an anterior transperitoneal abdominal approach followed by posterior stabilization and fusion from L2 to the pelvis.

Keywords:

abdominal; anterior approach; anterior transperitoneal exposure; corpectomy; lumbar vertebra.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1. A) Sagittal multiplanar reconstruction of lumbar CT demonstrating a two-column L4 burst fracture with retropulsed fracture fragments traverse the complete anterior-posterior (AP) spinal canal (orange arrow). There are changes of bone resorption with two-column fracture of also the L5 superior endplate (yellow arrow); B) Axial view at the L4-5 level showing severe canal compromise (yellow arrow); C) Coronal view showing the right pelvic and lumbar tilt (yellow arrows) due to the burst fracture; D) Volume-rendered 3D reconstruction with sagittal clip plane through the left lateral vertebral body plane.

Figure 2. A) Sagittal T2 Turbo Spine Echo (TSE) MRI of the lumbar spine demonstrates the L4 and L5 fractures with near complete loss of the intrathecal subarachnoid space. B and C) Sagittal and Axial T1 TSE DIXON water images with fat suppression were obtained of the lumbar spine after contrast administration. Images demonstrate associated enhancement consistent with inflammatory changes but no epidural abscess or focal mass lesion.

**Figure 3. Intra-operative view of corpectomy of L4 and L5 (blue arrow). Inferior vena cava (yellow arrow) and aorta (green arrow) both retracted laterally.**

Figure 4. A) Post-operative abdominal supine radiograph in the AP projection and B) Post-operative sagittal multiplanar reconstruction of the lumbar spine from an abdominal pelvic computed tomography demonstrating anterior stabilization of the spine using a K2M Capri Corpectomy cage and C) Post-operative abdominal supine AP radiograph demonstrating anterior and posterior stabilization

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