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  • Title: Lumbopelvic reconstruction after combined L5 spondylectomy and total sacrectomy for en bloc resection of a malignant fibrous histiocytoma.
    Author: Gallia GL, Suk I, Witham TF, Gearhart SL, Black JH, Redett RJ, Sciubba DM, Wolinsky JP, Gokaslan ZL.
    Journal: Neurosurgery; 2010 Aug; 67(2):E498-502. PubMed ID: 20644377.
    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.
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