title: Lumbopelvic reconstruction after combined L5 spondylectomy and total sacrectomy for en bloc resection of a malignant fibrous histiocytoma.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. ggallia1@jhmil.edu
authors.forename: Gary L
authors.initials: GL
authors.lastname: Gallia
authors.forename: Ian
authors.initials: I
authors.lastname: Suk
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
authors.forename: Susan L
authors.initials: SL
authors.lastname: Gearhart
authors.forename: James H
authors.initials: JH
authors.lastname: Black
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Redett
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
mesh_terms: D017809:Fatal Outcome; D005260:Female; D051677:Histiocytoma, Malignant Fibrous / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008161:Lumbosacral Region / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009362:Neoplasm Metastasis; D019637:Orthopedic Procedures / Q000379:methods; D010148:Intractable Pain / Q000209:etiology; D010388:Pelvis / Q000601:surgery*; D011183:Postoperative Complications; D011184:Postoperative Period; D019651:Plastic Surgery Procedures; D013125:Spinal Neoplasms / Q000473:pathology / Q000601:surgery*; D013131:Spine / Q000601:surgery*; D014057:Tomography, X-Ray Computed