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Research ArticleTumor

Safety and Neurologic Recovery of L2 Nerve Root Sacrificed in Total En Bloc Spondylectomy Involving the L2 Vertebra

Permsak Paholpak, Apiruk Sangsin, Winai Sirichativapee, Taweechok Wisanuyotin, Weerachai Kosuwon, Yuichi Kasai, Hideki Murakami and Hiroyuki Tsuchiya
International Journal of Spine Surgery December 2021, 15 (6) 1217-1222; DOI: https://doi.org/10.14444/8154
Permsak Paholpak
1 Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
2 Musculoskeletal Oncology Research Group, Khon Kaen University, Khon Kaen, Thailand
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Apiruk Sangsin
3 Department of Orthopaedics, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
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Winai Sirichativapee
1 Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
2 Musculoskeletal Oncology Research Group, Khon Kaen University, Khon Kaen, Thailand
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Taweechok Wisanuyotin
1 Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
2 Musculoskeletal Oncology Research Group, Khon Kaen University, Khon Kaen, Thailand
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Weerachai Kosuwon
1 Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
2 Musculoskeletal Oncology Research Group, Khon Kaen University, Khon Kaen, Thailand
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Yuichi Kasai
1 Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
2 Musculoskeletal Oncology Research Group, Khon Kaen University, Khon Kaen, Thailand
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Hideki Murakami
4 Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya city University, Nagoya, Japan
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Hiroyuki Tsuchiya
5 Department of Orthopaedic Surgery Graduate School of Medical Sciences, Kanazawa University, Japan
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  • Article
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Figures

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  • Figure 1
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    Figure 1

    The diaphragmatic crus from left side anterior retroperitoneal approach.

  • Figure 2
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    Figure 2

    En bloc laminectomy performed with a posterior approach using T-saw pediculectomy.

  • Figure 3
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    Figure 3

    L-shaped osteotome used to perform spondylectomy through posterior approach.

  • Figure 4
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    Figure 4

    MRI demonstrated single L2 level spinal metastasis with severe spinal canal compression.

  • Figure 5
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    Figure 5

    L2 Total en bloc spondylectomy (TES) was performed with bilateral L2 nerve root sacrificed.

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    Figure 6

    L2 TES specimen (TES, total en bloc spondylectomy).

Tables

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    Table 1

    Patients’ demographics and presenting symptoms.

    Patient No.SexAgeHistologyAffected VertebraSymptomsDuration,
    wk
    Preoperative Frankel GradeAdjuvant
    Treatment
    1M70CHCAL2Back pain
    Weakness
    6CCMT
    2F64CA lungL1, L2Back pain
    Weakness
    4CCMT + RT
    3F62CA lungL1, L2Back pain
    Weakness
    2CCMT + RT
    4M56CA lungL2Back pain
    Weakness
    4BCMT + RT
    5M64CA lungL1, L2Back pain
    Weakness
    3BCMT + RT
    6M27GCTL2Back pain
    Weakness
    4AZoledronic acid
    • CA lung, metastatic lung carcinoma; CHCA, cholangiocarcinoma; CMT, chemotherapy; F, female; GCT, giant cell tumor; M, male; RT, conventional radiation therapy at surgical site.

    • View popup
    Table 2

    The Eastern Cooperative Oncology Group (ECOG), Frankel grading, Oswestry Disability Index (ODI) at the last follow-up, and Manual Muscle Testing (MMT) of the iliopsoas (IP) and quadriceps (Qd) at preoperative and postoperative follow-up until last follow-up.

    Patient NumberMMT of IPMMT of QdECOGFrankel GradeTime to Self-Ambulation With Gait AidsODI
    (%)
    Last Follow-Up TimeCurrent Status
    PreopPostopLast
    F/U
    PreopPostopLast
    F/U
    PreopLastPreopLast
    F/U
    (mo)(mo) 
    122411432CaD3c3346Dead
    222522531CaE32612Alive
    322421432CbD3c52814Alive
    411511531BE51813Alive
    511511531BE62012Alive
    600500541AE31615Alive
    • F/U, follow-up.

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International Journal of Spine Surgery
Vol. 15, Issue 6
1 Dec 2021
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Safety and Neurologic Recovery of L2 Nerve Root Sacrificed in Total En Bloc Spondylectomy Involving the L2 Vertebra
Permsak Paholpak, Apiruk Sangsin, Winai Sirichativapee, Taweechok Wisanuyotin, Weerachai Kosuwon, Yuichi Kasai, Hideki Murakami, Hiroyuki Tsuchiya
International Journal of Spine Surgery Dec 2021, 15 (6) 1217-1222; DOI: 10.14444/8154

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Safety and Neurologic Recovery of L2 Nerve Root Sacrificed in Total En Bloc Spondylectomy Involving the L2 Vertebra
Permsak Paholpak, Apiruk Sangsin, Winai Sirichativapee, Taweechok Wisanuyotin, Weerachai Kosuwon, Yuichi Kasai, Hideki Murakami, Hiroyuki Tsuchiya
International Journal of Spine Surgery Dec 2021, 15 (6) 1217-1222; DOI: 10.14444/8154
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  • Laminectomy vs Fusion for Intradural Extramedullary Tumors
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Keywords

  • total en bloc spondylectomy
  • TES
  • L2 nerve root sacrifice
  • neurological function
  • neurological recovery

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