GIANT CELL TUMOUR OF THE SACRUM: FUNCTION-PRESERVING SURGERY WITH EXTENDED CURETTAGE AND ILIO-LUMBAR FUSION

Authors

  • Riaz H. Lakdawala
  • Tashfeen Ahmad
  • Syed A. Enam

Abstract

Giant cell tumours of the sacrum pose a unique therapeutic challenge due to the inaccessibility of the tumour, significant intra-operative blood loss from extensive vascularity, high rate of local recurrence with conservative surgery, and loss of neurological function and mechanical instability with en-bloc excision. We present a case where successful outcome was achieved by tailoring treatment in consideration of the above issues. A 28 year old male diagnosed on biopsy to have giant cell tumour of the sacrum presented to us with low-back pain, left-sided S1 radiculopathy, ankle weakness and urinary incontinence. MRI showed a tumour involving the S1 and S2 vertebral segments, breaching the posterior cortex and compressing the neural elements. An angiographic tumour embolization was performed followed by surgery through a posterior approach whereby an extended curettage was done, carefully freeing the sacral nerve roots and abrading the bone using high-speed burr. An ilio-sacro-lumbar fusion was done employing ilio-lumbar instrumentation and bone grafting. Post-operatively, within a week the patient was ambulated with a lumbar corset. At 9 months follow-up, the patient was completely pain free, had no ankle weakness, and had normal continence. This treatment approach resulted in preservation of neurologic function and maintenance of spinal stability, thus the patient returned to full function.Keyword: Giant cell tumour of bone; sacrum; selective arterial embolization; extended curettage; ilio-lumbar fusion; segmental instrumentation.

References

Leggon RE, Zlotecki R, Reith J, Scarborough MT. Giant cell tumour of the pelvis and sacrum: 17 cases and analysis of the literature. Clin Orthop Relat Res 2004; 423:196–207.

Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumour of bone. J Bone Joint Surg 1987;69:106–14.

Chakravarti A, Spiro IJ, Hug EB, Mankin HJ, Efird JT, Suit HD. Megavoltage radiation therapy for axial and inoperable giant-cell tumour of bone. J Bone Joint Surg Am 1999;81:1566–73.

Lackman RD, Khoury LD, Esmail A, Donthineni-Rao R. The treatment of sacral giant-cell tumours by serial arterial embolisation. J Bone Joint Surg Br 2002;84:873–7.

Lin PP, Guzel VB, Moura MF, Wallace S, Benjamin RS, Weber KL, et al. Long-term follow-up of patients with giant cell tumour of the sacrum treated with selective arterial embolization. Cancer 2002;95:1317–25.

Randall RL. Giant cell tumour of the sacrum. Neurosurg Focus 2003;15:E13.

Zhen W, Yaotian H, Songjian L, Ge L, Qingliang W. Giant-cell tumour of bone. The long-term results of treatment by curettage and bone graft. J Bone Joint Surg Br 2004;86:212–6.

Mindea SA, Salehi SA, Ganju A, Rosner MK, O'Shaughnessy BA, Jorge A, et al. Lumbosacropelvic junction reconstruction resulting in early ambulation for patients with lumbosacral neoplasms or osteomyelitis. Neurosurg Focus 2003;15(2):E6

Published

2013-07-01

Issue

Vol. 25 No. 3-4 (2013): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

CASE REPORT

License

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