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Lumbopelvic Reconstruction After Combined L5 Spondylectomy and Total Sacrectomy for En Bloc Resection of a Malignant Fibrous Histiocytoma

Gallia, Gary L. MD, PhD; Suk, Ian BSc, BMC; Witham, Timothy F. MD; Gearhart, Susan L. MD; Black, James H. III MD; Redett, Richard J. MD; Sciubba, Daniel M. MD; Wolinsky, Jean-Paul MD; Gokaslan, Ziya L. MD

Neurosurgery:
doi: 10.1227/01.NEU.0000382972.15422.10
Case Reports
Abstract

BACKGROUND: Primary sacral neoplasms that extend superiorly to involve the distal lumbar spine represent complex surgical problems. Treatment options for these patients are often limited to hemicorporectomy.

OBJECTIVE: To detail our surgical technique for en bloc resection of a sarcoma involving the L5 vertebral segment and sacrum and the reconstruction of the lumbopelvic junction.

METHODS: A 52-year-old woman presented with intractable pain secondary to a sarcoma involving the L5 vertebral segment and sacrum. She underwent a combined L5 spondylectomy and total sacrectomy for en bloc resection of her neoplasm. A novel lumbopelvic reconstruction technique was used to establish a liaison between the lumbar spine and pelvis.

RESULTS: Operative complications included a venous vascular injury and a nonviable myocutaneous flap. Postoperatively, the patient had complete resolution of her pain. Unfortunately, the patient developed metastatic disease and died 5 months after her initial surgical procedure.

CONCLUSION: We describe a patient who underwent a combined L5 spondylectomy and total sacrectomy for en bloc resection of a lumbosacral sarcoma. Additionally, we report a novel technique to reconstruct the lumbopelvic junction. The operative procedures are detailed with the aid of radiographs, intraoperative photographs, and illustrations.

Author Information

Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland (Gallia) (Suk) (Witham) (Sciubba) (Wolinsky) (Gokaslan)

Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland (Gearhart) (Black) (Redett)

Reprint requests: Gary L. Gallia, MD, PhD, Department of Neurosurgery, Johns Hopkins University School of Medicine, Phipps Bldg 118, 600 N Wolfe St, Baltimore, MD 21287. E-mail: ggallia1@jhmil.edu Or Ziya L. Gokaslan, MD, FACS, Department of Neurosurgery, Johns Hopkins University School of Medicine, Meyer 7–109, 600 N Wolfe St, Baltimore, MD 21287. E-mail: zgokasl1@jhmi.edu

Received, April 19, 2009.

Accepted, March 1, 2010.

Copyright © by the Congress of Neurological Surgeons