Primary Ewing’s Sarcoma of Lumbar spine treated with Neo-adjuvant Chemotherapy and Surgery- A Case Report

Abstract

Primary involvement of mobile spine compared to non-mobile spine is very less in case of Ewing’s sarcoma (ES). There are no fixed guidelines for these types of tumors because of their low incidence. These tumors usually have very high sensitivity to chemotherapy and radiotherapy. Goal for the management of ES of the spine is adequate local control through complete removal of tumor by doing aggressive resection along with restoration of spinal stability and preservation of neurology. En bloc spondylectomy or extralesional resection with wide disease-free margin provides good oncological results with a longer survival. Whenever it is possible to give neoadjuvant chemotherapy, it is always better because it helps to shrink tumor, treat micrometastasis, and make surgical excision easier with wide margin resection. However, in some case of spinal ES, it may not be possible because of neurological compromise and they might have to be addressed first by surgery and neurological decompression. We report here one such cases of primary ES of mobile lumbar spine treated with neoadjuvant chemotherapy and then with en bloc excision of tumor. The clinical picture and imaging characteristics of patient were analyzed as well as the management modalities and outcome has been discussed. Keywords: Ewing’s sarcoma, spine surgery, neoadjuvant chemotherapy, lumbar spine.