Evidence-Based Spine-Care Journal 2014; 05(02): 151-157
DOI: 10.1055/s-0034-1387804
Case Report
Georg Thieme Verlag KG Stuttgart · New York

L4 and L5 Spondylectomy for En Bloc Resection of Giant Cell Tumor and Review of the Literature

David R. Santiago-Dieppa1, Lee S. Hwang1, Ali Bydon1, Ziya L. Gokaslan1, Edward F. McCarthy2, Timothy F. Witham1
  • 1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • 2Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
Further Information

Publication History

23 December 2013

08 July 2014

Publication Date:
24 September 2014 (online)

Abstract

Study Design Case report and review of the literature.

Objective We present the case of a two-level lumbar spondylectomy at L4 and L5 for en bloc resection of a giant cell tumor (GCT) and lumbopelvic reconstruction.

Methods A 58-year-old woman presented with a 7-month history of progressive intractable back and leg pain secondary to a biopsy-proven Enneking stage III GCT of the L4 and L5 vertebrae. The patient underwent a successful L4–L5 spondylectomy and lumbopelvic reconstruction using a combined posterior and anterior approach over two operative stages.

Results Postoperative complications included a deep wound infection and a cerebrospinal fluid leak; however, following surgical debridement and long-term antibiotic treatment, the patient was neurologically intact with minimal pain and there was no evidence of tumor recurrence or instrumentation failure at more than 2 years of follow-up.

Conclusion Spondylectomy that achieves en bloc resection is a viable and effective treatment option that can be curative for Enneking stage III GCTs involving the lower lumbar spine. The lumbosacral junction represents a challenging anatomic location for spinal reconstruction after spondylectomy with unique technical considerations.