Case Report

Single stage en bloc resection of a recurrent metastatic osteosarcoma of the pediatric lumbar spine through multiple exposures – a novel approach

¹ Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
² Spine Surgery and Musculoskeletal Oncology, Houston Methodist Hospital, Houston, TX, USA
³ Paediatric Orthopaedics Department, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA

^* Corresponding author: emjohn24058@msn.com

Received: 18 June 2017
Accepted: 20 May 2018

Abstract

To obtain a wide resection and safe margins in recurrent spine osteosarcoma, the surgical approach can include – posterior only, combined posterior and anterior, and combined posterior and anterior with a return to posterior in multiple stages. In our case, we used a novel approach of multiple extensile exposures circumferentially in a single stage with a single surgical prep. We present the case of a 9-year-old female with a history of metastatic osteosarcoma, who previously underwent an attempted en bloc resection with an L3 corpectomy and left below knee amputation. At 1 year follow-up, she developed a recurrent solitary spine lesion at the previous surgical resection site. An additional attempt at complete surgical resection was performed with a complex en bloc L2, L3, L4 corpectomy with removal of deep spinal implants and anterior and posterior spinal fusion with instrumentation and revision decompressive laminectomy. The patient had a good functional outcome without neurological deficits, except those resulting from resection of involved lumbar nerve roots. At last follow-up of 5 months, there was no local recurrence or distant metastasis. This approach for revision resection of recurrent spinal osteosarcoma can be performed successfully with clean margins in a safe manner.