A novel method of anterior lumbosacral cage reconstruction: Technical note

Dimitrios Mathios, Paul Edward Kaloostian, Ali Bydon, Daniel M. Sciubba, Jean Paul Wolinsky, Ziya L. Gokaslan, Timothy F. Witham

Research output: Contribution to journalArticle

Abstract

Reconstruction of the lumbosacral junction is a considerable challenge for spinal surgeons due to the unique anatomical constraints of this region as well as the vectors of force that are applied focally in this area. The standard cages, both expandable and nonexpendable, often fail to reconstitute the appropriate anatomical alignment of the lumbosacral junction. This inadequate reconstruction may predispose the patient to continued back pain and neurological symptoms as well as possible pseudarthrosis and instrumentation failure. The authors describe their preoperative planning and the technical characteristics of their novel reconstruction technique at the lumbosacral junction using a cage with adjustable caps. Based precisely on preoperative measurements that maintain the appropriate Cobb angle, they performed reconstruction of the lumbosacral junction in a series of 3 patients. All 3 patients had excellent installation of the cages used for reconstruction. Postoperative CT scans were used to radiographically confirm the appropriate reconstruction of the lumbosacral junction. All patients had a significant reduction in pain, had neurological improvement, and experienced no instrumentation failure at the time of latest follow-up. Taking into account the inherent morphology of the lumbosacral junction and carefully planning the technical characteristics of the cage installation preoperatively and intraoperatively, the authors achieved favorable clinical and radiographic outcomes in all 3 cases. Based on this small case series, this technique for reconstruction of the lumbosacral junction appears to be a safe and appropriate method of reconstruction of the anterior spinal column in this technically challenging region of the spine.

Original languageEnglish (US)
Pages (from-to)204-208
Number of pages5
JournalJournal of Neurosurgery: Spine
Volume20
Issue number2
DOIs
StatePublished - Feb 1 2014

Keywords

  • Anterior spinal column reconstruction
  • Cage with adjustable caps
  • Cobb angle
  • Fusion
  • Lumbosacral junction
  • Oncology
  • Spondylectomy

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

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