Case: A 45-year-old female patient presented with acute perianal numbness, severe back pain, and bilateral radiculopathy. Magnetic resonance imaging revealed a large cystic lesion involving the L5–S1 vertebrae with compression of the thecal sac. Given the erosion of the L5 pedicle and sacral involvement, navigation-guided tumor resection with L4–S2 alar-iliac fixation and L4–5 transforaminal lumbar interbody fusion was performed. Intraoperative O-arm navigation ensured accurate resection and safe instrumentation despite distorted anatomy. Postoperatively, the patient had significant pain relief and neurological improvement at 1 year. Conclusion: Navigation-assisted resection with spinopelvic fixation is a safe and effective approach in complex schwannomas with bony erosion, ensuring maximal decompression, accurate instrumentation, and durable stability.
Kothari et al. (Thu,) studied this question.