Posterior minimally invasive percutaneous short-segment fixation combined with mini-open anterior L5 corpectomy for metastatic tumor: a case report and literature review.

Background: Metastatic tumors of the lumbar spine are a common complication of advanced malignancies. They often present with severe pain, neurological deficits, and spinal instability. Surgical removal of L5 vertebral body metastases is challenging due to the complex anatomy and biomechanical characteristics of the lumbosacral junction. Corpectomy using a combined approach is a common surgical strategy for achieving pain relief, adequate tumor resection, spinal cord and root decompression, and spinal stabilization. However, this approach may be associated with significant surgical trauma and blood loss. In this case report, we describe a surgical technique aimed at pain relief, mechanical stabilization, neurological preservation, and prevention of severe complications. Case description: A 62-year-old man with hepatocellular carcinoma presented with severe lumbar pain radiating to the left lower extremity, progressive lower limb weakness, and sensory deficits. Neurological examination revealed muscle strength of 3/5 in the lower extremities, Frankel grade C, and a Karnofsky Performance Status score of 40%. MRI and CT demonstrated metastatic destruction of the L5 vertebral body with spinal instability. The patient underwent a two-stage surgical procedure consisting of posterior minimally invasive percutaneous transpedicular fixation at the L4-S1 levels followed by mini-open anterior L5 corpectomy and anterior column reconstruction using a VLIFT titanium cage. Conclusion: The surgical procedure was performed without intraoperative complications. Total operative time was 4 h with an estimated blood loss of 800 mL. The patient was mobilized on the first postoperative day. Significant clinical improvement was observed: pain reduction from 8/10 to 2-3/10 on the Visual Analogue Scale and improvement in Karnofsky Performance Status from 40% to 80%. Postoperative CT confirmed adequate placement of the instrumentation and preservation of the posterior spinal column. Mini-open anterior L5 corpectomy combined with posterior minimally invasive percutaneous fixation may be a feasible surgical strategy for patients with L5 vertebral body metastasis. Preservation of the posterior spinal column may contribute to early mobilization, pain relief, and improved postoperative functional outcomes.