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Evid Based Spine Care J 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-Dieppa
1   Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,
Lee S. Hwang
1   Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,
Ali Bydon
1   Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,
Ziya L. Gokaslan
1   Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,
Edward F. McCarthy
2   Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,
Timothy F. Witham
1   Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
› Author Affiliations
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Publication History

23 December 2013

08 July 2014

Publication Date:
24 September 2014 (online)

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Commentary on: “L4 and L5 Spondylectomy for En Bloc Resection of Giant Cell Tumor and Review of the Literature”Evid Based Spine Care J 2014; 05(02): 158-159
DOI: 10.1055/s-0034-1387801

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.

Keywords

giant cell tumor - osteoclastoma - spondylectomy - lumbar spine - lumbopelvic reconstruction
 

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