腰椎腫瘍に対する腫瘍脊椎骨全摘術を試みた1例 : 後方,前側法アプローチの問題点

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We present a case report of a 72-year-old male patient with a solitary metastasis, probably from a renal carcinoma, to the lumbar vertebra at the L3 level, which we treated surgically with total en bloc spondylectomy (TES). At the time of admission, the patient had motor weakness in his right lower extremity due to compression of spinal nerve roots. We planned TES with spinal instrumentation by a combined posterior and lateral approach. His symptoms improved after surgery, and he eventually could walk by himself. We did not select a direct anterior approach because we were concerned about possible adhesions that might have developed following a prior anterior resection of a renal tumor. However, we were forced to leave in place the anterior portion of the L3 vertebra because the lateral approach prevented us from accessing the segmental artery on the contralateral side. Based on this experience, we would normally recommend a combined posterior and anterior approach for TES of a lumbar lesion in cases without any special circumstances.