Lumbar Corpectomy

The common thread is a vertebral body that can no longer do its job. In trauma, a high-energy burst fracture can shatter the vertebral body and push fragments of bone backwards into the spinal canal, threatening the nerves; simply stabilising from behind is sometimes not enough, and the front of the spine has to be rebuilt. In cancer, a tumour — usually a secondary deposit that has spread from elsewhere — can eat away the vertebral body, causing pain, instability and sometimes cord or nerve compression. In infection, an aggressive discitis or osteomyelitis can destroy the bone and form an abscess. In each case, removing the affected vertebral body allows me both to decompress the nerves thoroughly from the front and to replace the lost structural support.

A corpectomy means removing the vertebral body, along with the discs above and below it, and then filling the gap with a structural implant — most often an expandable titanium cage, packed with bone graft, that restores the height and takes the load. That reconstruction is almost always protected by pedicle-screw-and-rod fixation to hold everything solidly while it fuses. The vertebral body can be reached in different ways: directly from the front or side through the abdomen or flank (an anterior or lateral, retroperitoneal approach), or entirely from the back through a single posterior approach in which the body is removed around the nerves and the cage is placed from behind. The choice of approach depends on the level, the cause, your anatomy and general health, and whether the back of the spine also needs work. Modern expandable cages are valuable here because they can be inserted small and then expanded in place to fit the gap precisely and restore alignment.

The evidence supports corpectomy and cage reconstruction as an effective way to decompress the nerves and rebuild the anterior column across trauma, tumour and reconstruction. Case series of anterior and of single-stage posterior corpectomy with expandable cages report reliable decompression, restoration of height and alignment, and solid reconstruction, and comparative work shows that less invasive, mini-open and posterolateral routes can achieve the goals of surgery with reduced disruption in suitable patients. Because these operations are performed for serious underlying problems, the literature is also candid that they are major procedures with meaningful recovery; the balanced message is that, done for the right indication and planned well, corpectomy reliably achieves decompression and durable stabilisation.

A lumbar corpectomy is carried out under general anaesthetic and is a significant operation, usually with a hospital stay of several days and a recovery measured in months, supported by rehabilitation. The metalwork and cage provide immediate stability, so you can usually get up and begin moving soon after surgery, while the fusion consolidates over the following months. Where the surgery was done for a tumour or infection, it is one part of a wider treatment plan involving oncology or infection specialists. The specific risks depend on the approach and the underlying condition and are discussed fully beforehand, and the plan is always tailored to you as an individual.

• —Richardson B, et al. Anterior lumbar corpectomy with expandable titanium cage reconstruction: a case series of 42 patients. World Neurosurg 2017. (PMID 28887282)
• —Shen FH, et al. The use of an expandable cage for corpectomy reconstruction of vertebral body tumours through a posterior extracavitary approach. Spine J 2008. (PMID 17923442)
• —Sasani M, et al. Single-stage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fractures. Spine 2009. (PMID 19127146)
• —Joubert C, et al. Corpectomy and vertebral body reconstruction with expandable cage placement via the single-stage posterior approach: a retrospective series of 34 patients. World Neurosurg 2015. (PMID 26164192)
• —Lau D, et al. Posterior corpectomy with cage reconstruction for metastatic spinal tumours: mini-open versus open approach. J Neurosurg Spine 2015. (PMID 25932599)
• —Hunt T, et al. Expandable cage placement via a posterolateral approach in lumbar spine reconstructions. J Neurosurg Spine 2006. (PMID 16961091)
• —Felton J, et al. Nerve-sparing in situ assembly of an expandable titanium cage after posterior corpectomy for comminuted lumbar burst fractures. Oper Neurosurg 2023. (PMID 37499255)