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Skip Navigation LinksHome > August 2010 - Volume 67 - Issue 2 > Lumbopelvic Reconstruction After Combined L5 Spondylectomy a...
Neurosurgery:
doi: 10.1227/01.NEU.0000382972.15422.10
Case Reports

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

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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.

Copyright © by the Congress of Neurological Surgeons

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