Conversion of high sacral to midsacral amputation via S-2 nerve preservation during partial S-2 sacrectomy for chordoma

Technical note

Rajiv Saigal M.D., Ph.D. 1 , Daniel C. Lu M.D., Ph.D. 3 , Donna Y. Deng M.D., M.S. 2 , and Dean Chou M.D. 1
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  • 1 Departments of Neurological Surgery and
  • 2 Urological Surgery, University of California, San Francisco; and
  • 3 Department of Neurological Surgery, University of California, Los Angeles, California
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Chordomas of the sacrum require en bloc resection to reduce the risk of recurrence, but this may sacrifice nerves vital to bladder, bowel, and sexual function. High, mid-, and low sacral amputations have been previously classified based on nerve root sacrifice, not bony amputation. Sacrifice of the S-2 nerves or those above results in a high sacral amputation, but preserving the S-2 nerves converts it into a midsacral amputation. Preservation of the S-2 nerves has been shown to improve functional outcome, despite the bony osteotomy being unchanged. Thus, keeping the same bony amputation while preserving the S-2 nerve roots may allow for improved functional outcome while still achieving the same goal of oncological resection. Preservation of the S-2 nerves may be particularly difficult during amputation at the S-2 pedicle or above, and the authors describe their technique for preserving the S-2 nerves during partial sacrectomy at or just above the S-2 pedicle. Four cases of sacral chordoma resections are presented to illustrate the technique.

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Contributor Notes

Address correspondence to: Dean Chou, M.D., Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Box 0112, San Francisco, CA 94143-0112. email: choud@neurosurg.ucsf.edu.

Please include this information when citing this paper: published online February 14, 2014; DOI: 10.3171/2014.1.SPINE12652.

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