Posterior resection of fifth lumbar giant schwannoma combined with a recapping transiliac approach: case report and technical note

A two-stage combined anterior and posterior approach is commonly used for total resection of giant spinal tumors. However, an anterior approach at the lower lumbar level is technically challenging because of the anatomy of the iliac wing, major vessels and nerves of the lumbosacral plexus. We report a case of fifth vertebral tumor treated posteriorly with a newly devised surgical procedure combined with a recapping transiliac approach. A 45-year-old female diagnosed with giant schwannoma of the fifth lumbar vertebra underwent single-stage posterior tumor resection combined with osteotomy of the lateral part of the iliac crest. Without an anterior approach, tumor excision was completed with a wide view into the fifth lumbar vertebral body. Autogenous bone graft was harvested and used to treat the bone defect. The resected iliac bone was recapped and fixed with screws. The patient was monitored for 8 years without recurrence, and postoperative lumbar alignment remained unchanged. This surgical procedure is safe and a useful adjunct approach for posterior total resection of giant spinal tumors at the lower lumbar level.