Retroperitoneal Extrapleural Approach for Corpectomy of the First Lumbar Vertebra : Technique and Outcome

OBJECTIVE: Corpectomy of the first lumbar vertebra (L1) for the management of different L1 pathologies can be performed using either an anterior or posterior approach. The aim of this study was to evaluate the usefulness of a retroperitoneal extrapleural approach through the twelfth rib for performing L1 corpectomy.METHODS: Thirty consecutive patients underwent L1 corpectomy between 2010 and 2016. The retroperitoneal extrapleural approach through the 12th rib was used in all cases to perform single-stage anterior L1 corpectomy, reconstruction and anterior instrumentation, except for in two recurrent cases in which posterior fixation was added. Visual analogue scale (VAS) was used for pain intensity measurement and ASIA impairment scale for neurological assessment. The mean follow-up period was 14.5 months.RESULTS: The sample included 18 males and 12 females, and the mean age was 40.3 years. Twenty patients (67%) had sensory or motor deficits before the surgery. The pathologies encountered included traumatic fracture in 12 cases, osteoporotic fracture in four cases, tumor in eight cases and spinal infection in the remaining six cases. The surgeries were performed from the left side, except in two cases. There was significant improvement of back pain and radicular pain as recorded by VAS. One patient exhibited postoperative neurological deterioration due to bone graft dislodgement. All patients with deficits at least partially improved after the surgery. During the follow-up, no hardware failures or losses of correction were detected.CONCLUSION: The retroperitoneal extrapleural approach through the 12th rib is a feasible approach for L1 corpectomy that can combine adequate decompression of the dural sac with effective biomechanical restoration of the compromised anterior load-bearing column. It is associated with less pulmonary complication, no need for chest tube, no abdominal distention and rapid recovery compared with other approaches.

Retroperitoneal Extrapleural Approach for Corpectomy of the First Lumbar Vertebra : Technique and Outcome

OBJECTIVE: Corpectomy of the first lumbar vertebra (L1) for the management of different L1 pathologies can be performed using either an anterior or posterior approach. The aim of this study was to evaluate the usefulness of a retroperitoneal extrapleural approach through the twelfth rib for performing L1 corpectomy. METHODS: Thirty consecutive patients underwent L1 corpectomy between 2010 and 2016. The retroperitoneal extrapleural approach through the 12th rib was used in all cases to perform single-stage anterior L1 corpectomy, reconstruction and anterior instrumentation, except for in two recurrent cases in which posterior fixation was added. Visual analogue scale (VAS) was used for pain intensity measurement and ASIA impairment scale for neurological assessment. The mean follow-up period was 14.5 months. RESULTS: The sample included 18 males and 12 females, and the mean age was 40.3 years. Twenty patients (67%) had sensory or motor deficits before the surgery. The pathologies encountered included traumatic fracture in 12 cases, osteoporotic fracture in four cases, tumor in eight cases and spinal infection in the remaining six cases. The surgeries were performed from the left side, except in two cases. There was significant improvement of back pain and radicular pain as recorded by VAS. One patient exhibited postoperative neurological deterioration due to bone graft dislodgement. All patients with deficits at least partially improved after the surgery. During the follow-up, no hardware failures or losses of correction were detected. CONCLUSION: The retroperitoneal extrapleural approach through the 12th rib is a feasible approach for L1 corpectomy that can combine adequate decompression of the dural sac with effective biomechanical restoration of the compromised anterior load-bearing column. It is associated with less pulmonary complication, no need for chest tube, no abdominal distention and rapid recovery compared with other approaches.

Ventriculosubgaleal shunt in the management of obstructive hydrocephalus caused by cerebellar infarction

Cerebellar infarction is relatively uncommon. Small infarctions only cause cerebellar manifestations e.g. ataxia and nystagmus and are treated medically. Large cerebellar infarctions, however, can be life threatening. It cause brain stem compression and can obstruct the cerebrospinal fluid pathway causing obstructive hydrocephalus. It has to be treated promptly and may require besides the medical treatment surgical intervention as well. This is mainly in the form of posterior fossa decompression. In this study, we studied the beneficial effect of inserting a temporary ventriculoperitoneal shunt to relieve the supratentorial hydrocephalus in addition to posterior fossa decompression on the morbidity and mortality of patients in comparison to posterior fossa decompression alone. The aim of this study was to evaluate the role of ventriculosubgaleal shunt in cerebellar infarction causing supratentorial ventricular dilatation. This was a retrospective study that included ten patients having extensive cerebellar infarction causing spratentorial hydrocephalus. They were divided into two groups, group [1] was submitted to posterior fossa decompression alone and group [2] was submitted to posterior fossa decompression in addition to temporary ventriculosubgaleal shunt insertion. Group [2] which had posterior fossa decompression in addition to temporary. ventriculosubgaleal shunt hadmuch better results than group [1] which had only posterior fossa decompression. Group [2] had a lower morbidity and mortality and a shorter hospital stay than group [1]. Temporary insertion of ventriculosubgaleal shunt is recommended in patients having extensive cerebellar infarction causing supratentorial hydrocephalus in addition to posterior fossa decompression. It results in a lower morbidity and mortality and a shorter hospital stay