Sacral giant cell tumors are rare neoplasms, histologically benign but potentially very aggressive due to the difficulty in achieving a complete resection, their high recurrence rate, and metastization capability. Although many treatment options have been proposed, en bloc excision with tumor-free margins seems to be the most effective, being associated with long term tumor control, improved outcome, and potential cure. An exemplifying case of a 29-year-old female with progressive complaints of pain and paresthesias in the sacral and perianal regions, constipation, and weight loss for 6 months is presented. The surgical technique for en bloc excision of a large sacral giant cell tumor through a modified Kraske procedure with mid-sacrectomy and coccygectomy is described. Complete resection with wide tumor-free margins was achieved. At 5 years of follow-up the patient is neurologically intact, without evidence of local recurrence on imaging studies. A multidisciplinary surgical procedure is mandatory to completely remove sacral tumors. In the particular case of giant cell tumors, it allows minimizing local recurrence preserving neurovascular function, through a single dorsal and definitive approach.

Background: Spondylodiscitis is an uncommon disease, and due to its indolent nature, it is often a late diagnosis. Great stress is put on the etiologic diagnosis, but blood cultures do not always yield positive results. Magnetic resonance imaging (MRI), despite being the diagnostic method of choice, is not always available. Our aim was to characterize the clinical presentation and to identify and check the efficacy of the etiologic and radiological methods of diagnosis of spondylodiscitis used at our hospital.Methods: A retrospective study was conducted in which spontaneous spondylodiscitis cases were identified. The clinical presentation and the results of etiologic and radiological methods of diagnosis were analyzed.Results: Over a period of 5 years, 34 patients fulfilled the inclusion criteria of the study. Regarding days of complaints, we identified a median of 9.5 days (1-547 days), with back pain being the predominant symptom. Fever was present in half the patients. Blood cultures were positive in 16 patients (48.5%). Nineteen patients underwent a computed tomography (CT)-guided biopsy (positive in 7 patients [36.8%]), and 10 patients underwent a surgical biopsy (positive in half of them). Overall, 27 patients (79.4%) had an etiologic diagnosis. The diagnostic work-up consisted mostly of an initial CT scan followed by a confirmatory MRI. Of note, in 5 patients the CT scan did not reveal changes that were later confirmed by MRI. A total of 29 patients (85.3%) underwent an MRI, with 28 being diagnostic.Conclusions: Spondylodiscitis remain a difficult diagnosis. Blood cultures should always be obtained before antibiotic administration and a CT-guided or surgical biopsy should be done if needed. Our results confirm the importance of MRI as the imaging modality of choice and highlight the possibility of false-negative CT scans and the inability of CT to allow for a definitive diagnosis.