Stentoplasty-assisted Anterior Column Reconstruction with Navigation-guided Spinopelvic Fixation in an L5 Pathological Fracture Secondary to Vertebral Hemangioma - A Case Report.

Introduction: Pathological fracture due to vertebral hemangioma at the lumbosacral junction is exceedingly rare and poses unique challenges due to the region's high biomechanical demands and complex anatomy. While vertebral hemangiomas are typically asymptomatic or involve the thoracic spine, symptomatic presentation with neurological deficit and vertebral collapse at L5 is distinctly uncommon. This case report is among the few documented instances highlighting a concept-driven, biomechanically sound treatment strategy in such a scenario, contributing valuable insight to the orthopedic and spinal surgery literature. Case Report: A 69-year-old Indian male presented with severe low back pain radiating to the left lower limb, progressive motor weakness, and sensory deficits. Imaging revealed near-complete collapse of the fifth lumbar vertebral body with thecal sac compression, characteristic imaging features of vertebral hemangioma, and spinopelvic malalignment. He underwent a combination of vertebral body stenting and cement augmentation for anterior column reconstruction, along with image-guided spinopelvic fixation from the third lumbar vertebra to the second sacral alar-iliac level. Left-sided decompression was performed while preserving posterior midline structures. The patient's post-operative course was uneventful, with significant improvement in symptoms and restoration of spinal alignment. At 1-year follow-up, he reported sustained pain relief and full neurological recovery with radiologically maintained correction. Conclusion: This case illustrates a rare but clinically significant presentation of vertebral hemangioma leading to structural and neurological compromise at the lumbosacral junction. The application of vertebral body stenting and navigation-assisted spinopelvic fixation demonstrates an effective, concept-oriented approach to manage complex anterior column pathology while minimizing cement-related complications and preserving posterior stability. This report contributes to a deeper understanding of surgical strategies for treating hypervascular spinal tumors in biomechanically critical regions and holds broader implications for managing similar lesions with structural instability.