lumbar corpectomy is performed to fuse two vertebral
bodies together. It may be done for a fracture of the
lumbar vertebral body, or for significant compression of the
dura mater from the vertebral body. A good portion of
the vertebral body is drilled out and removed, and in its
place, a graft of bone is positioned. The goal is for
the graft to eventually join and fuse with the vertebral bodies
above and below. A plate may be placed across the entire
graft construct. The patient is taken to the operating
room, and the surgeon may first harvest hip bone from
the back or the front, or may use bone bank bone such as femur.
Next, the approach is made for the lumbar corpectomy
and fusion. This is done from the flank (side),
often behind the abdomen. In the upper lumbar area,
the diaphragm may need to be incised.. Once the
spine is exposed, the surgeon will perform the corpectomy,
and then he/she may place a plate for support and strength.
C- arm fluoroscopy (real time x-ray) is used to help
assist the surgeon in placement of the plate and screws.
After this is completed, closure will be performed.
The patient is then taken to the recovery room. The
surgeon may elect to leave the anterior corpectomy and fusion
as a stand alone procedure, or may supplement it with a posterior
fusion (from the back).
lumbar corpectomy and fusion does have some risks.
Risks of the procedure can be broken down into two categories,
1) those related to the operative site, and 2) those related
to the risks of anesthesia.
related to the operative site:
Exposure: The patient is placed in a supine position
(on their back), or on their side. In
this position, there can be pressure sores to the skin and
pressure injuries to nerves. Several large blood vessels
are exposed and these may be injured. If so, there
may be significant blood loss. In men, injury to nerves
located near the front of the spine may result in retrograde
ejaculation. If this is a concern, and the patient
desires to still have children, he may choose to first donate
to a sperm bank. In addition, there is risk of damage
to the ureters, which pass urine from the kidneys to the
bladder. The patient may experience pain in the hip
where the bone graft was taken from.
Cord/Nerve Root injuries: If there is any injury to the
spinal cord (in the upper lumbar area) or nerve roots,
the consequences may involve loss of sensation, increased
burning sensation, paralysis, weakness, loss of bowel, bladder,
sexual function. There is a risk of disc material
or bone being pushed into the spinal canal and compressing
the nerves. If there is significant scarring
(possibly from previous abdominal surgery), or if the major
blood vessels cannot be sufficiently moved, the surgeon
may have difficulty with access, and the intended
levels may be left unfused. There is also the possibility
that the fusion may not heal and the two vertebral bodies
surrounding the graft may remain unfused. There is
a possibility that the graft or plate may slip out toward
the abdomen or spinal nerves, postoperatively. The
vertebral bodies may slip on each other. It may be
necessary to perform a surgery from the back as well, either
to decompress nerve roots, or to fuse with bone graft and
Risks: When the hardware (instruments placed to hold
the spine together) is placed, nerve roots or the spinal
cord can be injured. In addition, the bone may not
properly fuse. The propensity for non-fusion and continued
pain is higher in smokers. Cessation of smoking improves
the chances of a successful fusion. There can be pain
and the standard risks of bleeding and infection associated
with the site on the body from which the bone for grafting
is taken (often the hip). IIf bone bank bone is used
for grafting, there is an extremely small chance of infection
and HIV. In addition, hardware can break and pull
out from the spine.
Risks: These include general difficulties, such
as bleeding, infection, stroke, paralysis, coma and death.
Incisions on the abdomen and flank generally heal
well, but there may be tenderness, or the wound may heal
in an unpleasant manner. There is also the possibility
that the surgery may not relieve the symptoms for which
the procedure was performed. The problem for which
the surgery was performed may recur, requiring additional
surgery in the future. In addition, although every
attempt is made to protect all areas of the body from pressure
on nerves, skin and bones, injuries to these areas can occur,
particularly with prolonged cases.
Blood clots in the legs, heart attacks, reaction to the
anesthetic, reaction to blood transfusion, if it given.
Bone can bleed quite a bit, and if sufficient amounts of
blood are lost during the surgery, a transfusion may be
shall be no bending, twisting, or heavy lifting for several
weeks after surgery. Physical therapy may or may not
be implicated. Your doctor will gradually ease your
work restrictions, depending on your progress. You will
likely be required to wear a lumbar brace or corset for three
months after surgery.
to keep the wound dry and clean. Notify your surgeon
of any drainage or temperatures greater than 101 Fahrenheit.
of this surgery was to fuse the vertebral bodies in your
back. We expect you to eventually do normal activities
better because of the surgery. Some continuing back
and leg pain is not unusual during the first few days and
weeks following surgery. Hurt does not necessarily mean
harm. You may experience numbness in the foot or leg,
but this does not impair function. The following is
a list of suggestions that should help speed your recovery
and give you every possible chance for the best results from
upon discharge, contact our office and set up an appointment
for staple removal if one has not already been set up.
it easy until seen by the physician. This does not
mean bed rest, but athletic activities during this period
are definitely not recommended. Please give your incision
a chance to heal. Avoid bending.
your lumbar brace or corset as prescribed by your surgeon.
nothing heavier than a half gallon of milk until seen by
sitting for periods of time longer than 45 minutes.
It is OK to sit in a lounge chair which is laid back, for
as long as you wish.
jogging or running.
you get home, you may begin walking up to one mile per day.
may walk up or down steps as often as you like. Please
take them smoothly and slowly.
driving until OK with your physician. Do not ride
further than 50 miles at a time. This applies
during the first month after surgery.
may shower after you go home unless otherwise instructed.
Cover the incision with plastic wrap before the shower and
remove it afterward. Change dressing immediately.
Tub baths are not advisable. You may shower without
covering the incision one week after the staples are out.
Follow instructions concerning care of tape strips, stitches
or staples. Your surgeon or his nurse clinician will
explain the techniques used in the closure of your incision.
activities are permitted.
you notice swelling, redness or opening of the incision,
or if there is any clear fluid draining from it, please
contact your surgeon immediately! If you develop a
fever, stiff neck or chills, contact the office immediately.
Take your temperature at 4:00 PM daily until the clips are
removed. Call if greater than 101 degrees Fahrenheit.
you have any questions, call our office, and for after hours
emergencies, call the after hours number.
your medications prescribed on discharge, as directed.
takes 6 - 12 months for a fusion to heal. Be patient.
avoid smoking, as it decreases likelihood of a successful