Single stage combined approach total en-bloc spondylectomy of L1 and L2 vertebrae for primary spinal and paraspinal synovial sarcoma.

Background: Spinal synovial sarcomas are the rarest of synovial soft tissue sarcomas. Limited data exist about their epidemiology, management, and oncological and functional outcomes. Multi-segment total en-bloc spondylectomy (TES) is challenging and requires appropriate reconstruction to achieve satisfactory oncological and functional outcomes.

Case presentation: A 26-year-old lady was evaluated for bilateral knee pain with magnetic resonance imaging-computed tomography (MRI-CT) and CT guided biopsy and was diagnosed to have non-metastatic synovial sarcoma of the left paraspinal tissue involving the L1 and L2 vertebrae extending into the paravertebral space, neural foramen of L1-L2 and L2-L3 with nerve root compression at L2 level. The patient underwent single-stage multi-segment (L1-L2) TES (posterior-anterior approach) with en-bloc excision of the paravertebral component with vertebral reconstruction followed by adjuvant radiation and chemotherapy. Physiotherapy was used for post-operative functional optimisation. During the follow-up period, the patient had graft failure and fracture of the spinal fixation rods, which were managed surgically with replacements and fixation. The patient is on follow-up with a disease-free survival of 120 months without any neurological deficit, normal gait, and spinal mobility.

Conclusion: Multi-segment TES is a safe surgical approach for vertebral malignancy with appropriate reconstruction, which offers better oncological and functional outcomes.