Navigation-Guided Resection of a Cystic Schwannoma with Spinopelvic Fixation in Acute Cauda Equina Syndrome: A Case Report.

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.