Surgical Management of Lumbosacral Giant Invasive Spinal Schwannoma: A Case Report and Literature Review.

Abstract

Giant invasive spinal schwannomas (GISSs) comprise a rare, specific subtype of schwannomas that extend >2 spinal levels, erode vertebral bodies, and invade extraspinal tissues. Optimal surgical management of resulting spinal instability has yet to be determined, and overall there is limited published literature on GISS. We report an innovative method used to treat a rare case of lumbosacral GISS using a triangular frame reconstruction to reconnect the spinal column to the pelvis after tumor debulking. This method of using femur allograft in lieu of metal rods can promote stronger bony fusion of the construct. A 19-year-old woman presented with worsening lower back pain, which was due to a giant invasive spinal schwannoma that invaded the L4-S1 vertebral bodies and extended intrathecally from T10-S2, compromising the stability of her spine. The primary resection of the tumor was completed in 3 stages and was followed by a multilevel fusion involving a triangular construct made of femur allograft to reconnect the unstable spinal column with the pelvis. Maximal resection of the tumor was achieved with early rehabilitation. Pseudoarthrosis occurred, which was successfully fused after revision with the addition of an implanted bone stimulator. Seven years later, she remains in stable neurological condition. We recommend the use of femur allograft in triangular frame constructs for lumbosacral GISS to foster more stable, physiologic spinopelvic fusion.