Anterior Lumbar Corpectomy and Fusion
Overview and Indications
Anterior lumbar corpectomy and fusion is a special type of spinal decompression and fusion procedure that utilizes an anterolateral (side of the body incision) approach to remove bone and tissue that is causing compression of the spinal cord and nerves. However, in order to do so generally involves removing nearly the entire vertebral body and disc, which must be replaced with a piece of bone graft and fused together to maintain stability. A small metal plate with screws may also be used to add additional stability.
This type of surgery is most often performed for patients with a spinal fracture, tumor or infection causing compression of the spinal nerves. Anterior corpectomy and fusion can also be performed in the chest region or thoracolumbar (lower chest/mid-back) region, depending on where the neurologic compression is located. The primary advantage of performing an anterolateral approach over a posterior surgery is that there is a much wider exposure of the bone, disc and lesion causing neurologic compression, which can be removed without retraction of the spinal cord and neurologic structures, which decreases risk of neurologic injury and increased chance of improvement.
Patients with a severe spinal problem or instability may also require a posterior spinal fusion with metal instrumentation in addition to an anterior corpectomy and fusion. If necessary, the second surgery is typically performed in a staged fashion one to four days after the first anterior surgery.
Most patients are usually able to go home four to seven days after surgery. Patients will typically stay longer, approximately six to 10 days, if a posterior spinal surgery is also performed. Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. Patients are instructed to avoid bending at the waist, lifting more than five pounds and twisting in the early postoperative period (first two to four weeks) to avoid a strain injury. Patients can gradually begin to bend, twist and lift after four to six weeks as the pain subsides and the back muscles get stronger.
Patients may be issued a soft or rigid lumbar corset that can provide additional thoracic and/or lumbar support in the postoperative period, if necessary.