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Rajaraman Ramamurthy, Jagadish Chandra Bose, Vimalakannan Muthusamy, Mayilvahanan Natarajan and Deiveegan Kunjithapatham

S acral tumors comprise a heterogeneous group of neoplasms ranging from benign, benign aggressive, malignant, to metastatic in origin. Patients presenting with sacral neoplasm range in age from very young with teratomas to very elderly with metastatic disease. The most common primary sacral tumors are chordoma, GCT, chondrosarcoma, and plasmocytoma. Secondary infiltration of the sacrum by rectal carcinoma and retroperitoneal tumor can occur. The most common tumors requiring sacrectomy are primary sacral tumors and rectal carcinoma infiltrating the sacrum

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Ken Ishii, Kazuhiro Chiba, Masahiko Watanabe, Hiroo Yabe, Yoshikazu Fujimura and Yoshiaki Toyama

past few decades, improvements in surgical techniques have brought encouraging treatment-related results. 5, 14, 18–20 Despite the prevalence of such advanced surgical techniques, local recurrence is not rare even after total en bloc resection. The present study was undertaken to investigate the details of recurrences after en bloc sacrectomy at the S2–3 level to recommend a wider modification of an existing approach for sacral chordoma located below S-3. Case Reports Clinical Findings Six patients with a sacral chordoma located below the level of S-3 have

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Jennifer E. Kim, John Pang, Joani M. Christensen, Devin Coon, Patricia L. Zadnik, Jean-Paul Wolinsky, Ziya L. Gokaslan, Ali Bydon, Daniel M. Sciubba, Timothy Witham, Richard J. Redett and Justin M. Sacks

T otal en bloc sacrectomy is a dramatic surgical procedure that requires complex bony and soft-tissue reconstruction. Radical oncological resection is warranted for very large, aggressive, benign tumors (i.e., giant cell tumors, osteoblastomas) or low-grade malignant tumors (i.e., chordomas, lymphomas) that extend up to or beyond the first sacral vertebra. Unlike partial or hemisacrectomy, total sacral amputation results in the bilateral disarticulation of the sacroiliac joint; biomechanical stability is subsequently restored with pelvic reconstruction in

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Ying Guo, J. Lynn Palmer, Loren Shen, Guddi Kaur, Jie Willey, Tao Zhang, Eduardo Bruera, Jean-Paul Wolinsky and Ziya L. Gokaslan

C hordoma , chondrosarcoma, meningioma, ependymoma, and giant cell tumors are cancers of relatively low-level malignancy but usually associated with a high potential for local recurrence. Total or partial sacrectomy is the procedure of choice for treatment of these and other locally invasive tumors such as rectal cancer. 1, 3, 4, 10, 12–16, 19 Investigators have shown, however, that neurological dysfunction, such as lower-extremity motor weakness, sensory abnormalities, and bowel, bladder, and sexual dysfunction, can occur following sacrectomy and are

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Gary L. Gallia, Raqeeb Haque, Ira Garonzik, Timothy F. Witham, Yevgeniy A. Khavkin, Jean Paul Wolinsky, Ian Suk and Ziya L. Gokaslan

T he treatment of primary sacral tumors represents a challenge because of their anatomical location and often large tumor mass at presentation. Radical resection has been demonstrated to prolong the progressionfree survival period in patients harboring various primary sacral neoplasms that are unresponsive to nonoperative therapy. 2, 3, 11, 14, 24 The location of the tumor within the sacrum determines whether a partial or total sacrectomy will be necessary to achieve a radical resection. Moreover, the extent of sacral resection dictates the extent of spinal

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Konstantinos A. Starantzis, Vasileios I. Sakellariou, Peter S. Rose, Michael J. Yaszemski and Panayiotis J. Papagelopoulos

postoperative function. Total sacrectomy is a surgical procedure used for tumor resections, resulting in significant neurological deficit regardless of the type of reconstruction. 6 , 18 , 54 , 55 , 58 The type of sacral resection required to achieve local control will vary depending on the location, extent, and type of tumor. The level of sacrectomy is usually predictive of the resultant neurological deficit. Sacrifice of the S2–4 nerve roots bilaterally results in urinary and fecal incontinence, and impotence for males. 3 , 26 , 51 Unilateral preservation of the S-2 root

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Christopher C. Gillis, John T. Street, Michael C. Boyd and Charles G. Fisher

neither radiation therapy nor chemotherapy has been shown to be effective or to have influence on the patient’s prognosis. 2 The goal of surgical treatment is en bloc excision with wide margins. When these lesions involve the sacrum, a total or partial sacrectomy is then required to achieve en bloc excision with margins. 14 When the tumor also involves the lumbar spine, the technical difficulty of both resection to achieve clear margins and postresection reconstruction increases considerably. 5 Following en bloc excision of a sacral chondrosarcoma, the patient may

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Mohamed Macki, Rafael De la Garza-Ramos, Ashley A. Murgatroyd, Kenneth P. Mullinix, Xiaolei Sun, Bryan W. Cunningham, Brandon A. McCutcheon, Mohamad Bydon and Ziya L. Gokaslan

S acral neoplasms with an aggressive nature or diffuse infiltration may require en bloc resection to achieve the longest disease-free survival. 16 En bloc resections may require a complete removal of the sacrum, or total sacrectomy, which not only disrupts the continuity between the lumbar spine and pelvis but also destabilizes the biomechanical integrity of the spinal column. In a technical note in 1997, the first total sacrectomy reconstruction technique performed using a Galveston L-rod was described. 7 The instrumentation technique was adopted from Allen

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Aaron J. Clark, Jessica A. Tang, Jeremi M. Leasure, Michael E. Ivan, Dimitriy Kondrashov, Jenni M. Buckley, Vedat Deviren and Christopher P. Ames

T otal sacrectomy remains central to the treatment of certain aggressive malignant sacral tumors with S-1 involvement. However, the sacrum functions as an important load transfer interface between the lower extremity (via the pelvis) and the spinal column. Extent of resection is significantly associated with spinopelvic postoperative stability, as demonstrated in biomechanical testing of cadaveric specimens. With partial sacrectomy, resection between S-1 and S-2 decreases stability by 30% in axial loading, whereas resection through the S-1 body decreases

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Mehmet Zileli, Cüneyt Hoscoskun, Priscilla Brastianos and Dündar Sabah

Object

Sacral tumors are relatively rare, and experience related to resection of these tumors is therefore usually limited to a small number of patients. The purpose of this retrospective study was to review the authors' experience with sacral neoplasms over the last 12 years.

Methods

Based on a review of records in 11 patients who underwent sacrectomy, and the various patient characteristics, presenting symptoms, histological findings for their tumors, as well as the type of surgical treatment used (including a whole spectrum of sacral amputations), and their outcome are reported.

Conclusions

Despite the potential for complications, sacrectomy can be performed successfully, and is an important procedure in the treatment of primary sacral tumors.