title: En Bloc Resection of a Giant Cell Tumor in the Sacrum via a Posterior-Only Approach Without Nerve Root Sacrifice: Technical Case Report.
abstract: BACKGROUND
  Giant cell tumors (GCTs) are rare primary bone neoplasms. The best long-term prognosis is achieved via complete tumor excision, but this feat is challenging in the spine due to proximity of blood vessels and nervous tissue. When occurring in the sacrum, GCTs have been removed in an en bloc fashion via combined anterior/posterior approaches, oftentimes with nerve root sacrifice. The purpose of this article is to present a case of a single-staged, posterior-only approach for en bloc resection of a sacral GCT without nerve root sacrifice.
  
  
  METHODS
  A 45-year-old female presented with intractable lower back and leg pain, saddle anesthesia, and lower extremity weakness. She underwent imaging studies, which revealed a lesion involving the S1 and S2 vertebral bodies. Computed tomography guided biopsy revealed the lesion to be a GCT. The patient underwent a posterior-only approach without nerve root sacrifice to achieve an en bloc resection, followed by lumbopelvic reconstruction.
  
  
  CONCLUSIONS
  Sacrectomy via a single-staged posterior approach with nerve root preservation is a challenging yet feasible procedure for the treatment of giant cell tumors in carefully selected patients.
authors.affiliation: ‡The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland; §Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Bydon
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza-Ramos
authors.forename: Chetan
authors.initials: C
authors.lastname: Bettegowda
authors.forename: Ian
authors.initials: I
authors.lastname: Suk
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
mesh_terms: D001174:Arthrodesis / Q000379:methods; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000150:complications / Q000601:surgery*; D006801:Humans; D017116:Low Back Pain / Q000209:etiology; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D019635:Neurosurgical Procedures / Q000379:methods*; D010148:Intractable Pain / Q000209:etiology; D016684:Prone Position; D012447:Sacrum / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome