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Surgical techniques for spinopelvic reconstruction following total sacrectomy: a systematic review

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Abstract

Purpose

To identify all available reconstruction methods for a total sacrectomy. Secondarily, we aimed to evaluate outcomes based on different interventions.

Methods

We searched PubMed to identify sacral resections for tumors requiring internal fixation for stabilization. Demographic information, fixation techniques and postoperative outcomes were abstracted.

Results

Twenty-three publications (43 patients) met inclusion criteria from an initial search of 856 (κ 0.93). Mean age was 37 years and follow-up was 33 months. Fixation methods included a combination of spinopelvic fixation (SPF), posterior pelvic ring fixation (PPRF), and/or anterior spinal column fixation (ASCF). For the purposes of analysis, patients were segregated based on whether they received ASCF. Postoperative complications including wound/instrument infections, GI or vascular complications were reported at a higher rate in the non-ASCF group (1.63 complications/patient vs. 0.7 complications/patient). Instrument failure was seen in 5 (16.1 %) out of the 31 patients with reported outcomes. Specifically, 1 out of 8 patients (12.5 %) with ASCF compared with 4 out of 23 patients (17.4 %) without ASCF had hardware failure. At final follow-up, 35 of 39 patients were ambulating.

Conclusion

While surgical treatment of primary sacral tumors remains a challenge, there have been advances in reconstruction techniques following total sacrectomy. SPF has shifted from intrapelvic rod and hook constructs to pedicle and iliac screw–rod systems for improved rigidity. PPRF and ASCF have adapted for deficiencies in the posterior ring and anterior column. A trend toward a lower rate of hardware failure emerged in the group utilizing anterior spinal column support. Despite a more involved reconstruction with ASCF, surgical complications such as infection rates and blood loss were lower compared to the group without ASCF. While we cannot definitively say one system is superior to the other, based on the data gleaned from this systematic review, it is our opinion that incorporation of ASCF in reconstructing the spinopelvic junction may lead to improved outcomes. However, most importantly, we recommend that the treating surgeon operate on patients requiring a total sacrectomy based on his or her level of comfort, as these cases can be extremely challenging even among experts.

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Conflict of interest

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California at Irvine, 101 The City Drive South, Pavilion III, Orange, CA, 92868, USA

    S. Samuel Bederman, Kalpit N. Shah, Jeffrey M. Hassan, Bang H. Hoang, P. Douglas Kiester & Nitin N. Bhatia

Authors
  1. S. Samuel Bederman
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  2. Kalpit N. Shah
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  3. Jeffrey M. Hassan
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  4. Bang H. Hoang
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  5. P. Douglas Kiester
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  6. Nitin N. Bhatia
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Corresponding author

Correspondence to S. Samuel Bederman.

Appendix: search strategy to capture all relevant articles in the Pubmed database

Appendix: search strategy to capture all relevant articles in the Pubmed database

General scheme

[(“tumor terminology” AND “sacral area terminology”) OR (“sacral resection terminology”)] AND [(“reconstruction terminology”)]

Search terms

Tumor terminology

(Metastasis OR (metastatic AND (tumor OR tumour OR disease OR neoplasm)) OR primary tumor OR: “neoplasm”[Mesh] OR neoplasm OR “Neoplasm metastasis”[Mesh] OR bone neoplasms OR “bone neoplasms”[mesh] OR “pelvic neoplasms”[Mesh] OR pelvic neoplasms OR “Chondrosarcoma”[Mesh] OR chondrosarcoma OR “Giant cell tumor”[Mesh] OR giant cell tumor OR “Lymphoma”[Mesh] OR lymphoma OR “Multiple Myeloma”[Mesh] OR myeloma OR “Plasmacytoma”[Mesh] OR plasmacytoma OR Ewing Sarcoma OR “Chordoma”[Mesh] OR chordoma OR “Osteosarcoma”[Mesh] OR osteosarcoma OR osteogenic sarcoma OR “Spinal Neoplasms”[Mesh] OR spinal neoplasms OR “Bone Cysts, Aneurysmal”[Mesh] OR Aneurysmal bone cysts)

Sacral area terminology

(sacrum OR sacral OR “Sacrum”[Mesh] OR “Lumbosacral Region”[Mesh] OR lumbosacral OR lumbo-sacral OR spinal pelvic OR spinal-pelvic OR spino-pelvic OR spinopelvic OR sacroiliac OR sacro-iliac OR iliosacral OR ilio-sacral OR lumbo-pelvic OR lumbopelvic OR lumboiliac OR lumbo-iliac OR lumbosacropelvic)

Sacral resection terminology

(total sacrectomy OR (en bloc resection) OR (enbloc resection) OR ((sacral OR sacrum) AND (resection)))

Reconstruction terminology

((Galveston OR galveston L-rod OR galveston rod OR L-rod) AND (instrumentation OR technique OR fixation)) OR ((sacrum OR sacral OR “Sacrum”[Mesh] OR “Lumbosacral Region”[Mesh] OR lumbosacral OR lumbo-sacral OR spinal pelvic OR spinal-pelvic OR spino-pelvic OR spinopelvic OR sacroiliac OR sacro-iliac OR iliosacral OR ilio-sacral OR lumbo-pelvic OR lumbopelvic OR lumboiliac OR lumbo-iliac OR lumbosacropelvic) AND (stabiliz* OR stabilis* OR stable OR stability OR fixation OR reconstruction OR screw)) OR (“fracture fixation”[mesh]) OR (fixation) OR (“Internal Fixators”[Mesh] OR internal fixators) OR (“Bone Screws”[Mesh] OR bone screws) OR ((transiliac OR trans-iliac) AND (bar OR rod OR screw)) OR (“Orthopedic Procedures”[Mesh] OR orthopedic procedures OR orthopaedic procedures OR “Reconstructive Surgical Procedures”[Mesh] OR reconstructive surgical procedures))

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Bederman, S.S., Shah, K.N., Hassan, J.M. et al. Surgical techniques for spinopelvic reconstruction following total sacrectomy: a systematic review. Eur Spine J 23, 305–319 (2014). https://doi.org/10.1007/s00586-013-3075-z

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  • DOI: https://doi.org/10.1007/s00586-013-3075-z

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