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Posterior Lumbar and Sacral Approach and Stabilization: Intralesional Lumbar Resection

  • John H. ShinEmail author
  • Ganesh M. Shankar
Chapter

Abstract

The posterior approach to the lumbar spine and sacrum is familiar to most spine surgeons and avoids the need for an access surgeon. Given the familiarity of this technique, the posterior approach is a workhorse for most spine surgeons when treating tumors in this region. For most situations involving metastatic tumors to the spine, an intralesional tumor debulking strategy is used to decompress the nerve roots, separate tumor from the dura, and simultaneously stabilize the spine. The advantage of the posterior approach is that this can all be done in the same setting.

Unlike the treatment for primary spinal column tumors such as chordoma and chondrosarcoma where en bloc, excisional-type resection strategies are ideal for local tumor control and potential cure, in the metastatic setting, the intent is not usually curative. Thus, the scope and extent of surgery required in this region is usually limited. The posterior approach is effective in this regard as it minimizes the surgical morbidity associated with either anterior or lateral approaches to the lumbar spine and sacrum. Given the goals of addressing cancer-related biologic and mechanical pain in the least destructive manner in the palliative setting, the posterior approach helps minimize the potential complications associated with the other approaches.

In this chapter, the regional challenges of posterior fixation, decompression, and reconstruction are discussed through a case-based approach in a practical manner.

Keywords

Intralesional tumor resection Spinal metastases Posterior stabilization Spinal reconstruction Separation surgery Palliative surgery 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Massachusetts General HospitalDepartment of Neurosurgery, Harvard Medical SchoolBostonUSA

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