Case Report: Giant L1 dumbbell-shaped spinal schwannoma with osteolytic destruction and intense [18F]FDG uptake on PET/CT mimicking a malignant tumor

Background: F]FDG uptake may mimic malignant tumors, creating diagnostic uncertainty and substantial surgical challenges related to neural decompression, maximal safe resection, and spinal stabilization. Case presentation: F]FDG uptake (SUVmax 10.2), without additional suspicious skeletal or visceral lesions. The patient underwent a posterior-only, single-stage resection of both the epidural intraspinal and large extraspinal components, followed by long-segment instrumented fusion (T11-L3) and posterolateral grafting because of tumor-related pedicle/vertebral destruction and iatrogenic instability. Histopathology confirmed schwannoma with S-100 and SOX10 positivity and a low Ki-67 index (~3%). Postoperatively, pain and radicular symptoms improved with neurological recovery; radiographs demonstrated satisfactory implant position without evidence of screw loosening. Conclusion: F]FDG uptake and osteolytic changes yet remain benign. For selected destructive dumbbell-shaped schwannomas spanning the paravertebral, foraminal, and intraspinal compartments, a posterior-only, single-stage approach may achieve effective decompression and facilitate immediate stabilization in selected patients when anatomical accessibility and mechanical considerations are favorable.