En bloc hemisacrectomy and internal hemipelvectomy via the posterior approach

Technical note

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Object

Traditionally, hemisacrectomy and internal hemipelvectomy procedures have required both an anterior and a posterior approach. A posterior-only approach has the potential to complete an en bloc tumor resection and spinopelvic reconstruction while reducing surgical morbidity.

Methods

The authors describe 3 cases in which en bloc resection of the hemisacrum and ilium and subsequent lumbopelvic and pelvic ring reconstruction were performed from a posterior-only approach. Two more traditional anterior and posterior staged procedures are also included for comparison.

Results

In all 3 cases, an oncologically appropriate surgery and spinopelvic reconstruction were performed through a posterior-only approach.

Conclusions

The advantage of a midline posterior approach is the ability to perform a lumbosacral reconstruction, necessary in cases in which the S-1 body is iatrogenically disrupted during tumor resection.

Abbreviations used in this paper:ASIS = anterior superior iliac spine; PSIS = posterior superior iliac spine; SI = sacroiliac.
Article Information

Contributor Notes

Address correspondence to: Michelle Clarke, M.D., 200 First St. SW, Rochester, MN 55905. email: clarke.michelle@mayo.edu.Please include this information when citing this paper: published online June 13, 2014; DOI: 10.3171/2014.4.SPINE13482.
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References
  • 1

    Clarke MJDasenbrock HBydon ASciubba DMMcGirt MJHsieh PC: Posterior-only approach for en bloc sacrectomy: clinical outcomes in 36 consecutive patients. Neurosurgery 71:3573642012

    • Search Google Scholar
    • Export Citation
  • 2

    Combalía AFernández-Valencia JARamón RSegur JMGarcía SSuso S: Long-term results of hemipelvic allograft: report of four cases. Cell Tissue Bank 3:41442002

    • Search Google Scholar
    • Export Citation
  • 3

    Dasenbrock HHClarke MJBydon AMcGirt MJWitham TFSciubba DM: En bloc resection of sacral chordomas aided by frameless stereotactic image guidance: a technical note. Neurosurgery 70:1 Suppl Operative82882012

    • Search Google Scholar
    • Export Citation
  • 4

    Dasenbrock HHClarke MJBydon AWitham TFSciubba DMSimmons OP: Reconstruction of extensive defects from posterior en bloc resection of sacral tumors with human acellular dermal matrix and gluteus maximus myocutaneous flaps. Neurosurgery 69:124012472011

    • Search Google Scholar
    • Export Citation
  • 5

    Di Mauro DD'Hoore APenninckx FDe Wever IVergote IHierner R: V-Y bilateral gluteus maximus myocutaneous advancement flap in the reconstruction of large perineal defects after resection of pelvic malignancies. Colorectal Dis 11:5085122009

    • Search Google Scholar
    • Export Citation
  • 6

    Diaz JMcDonald WSArmstrong MEismont FHellinger MThaller S: Reconstruction after extirpation of sacral malignancies. Ann Plast Surg 51:1261292003

    • Search Google Scholar
    • Export Citation
  • 7

    Enneking WFDunham WK: Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am 60:7317461978

    • Search Google Scholar
    • Export Citation
  • 8

    Fitzwilliams DC: Hindquarter amputation for sarcoma. Proc R Soc Med 31:5485501938

  • 9

    Fourney DRGokaslan ZLSurgical approaches for the resection of sacral tumors. Dickman CMFehlings MGGokaslan ZL: Spinal Cord and Spinal Column Tumors: Principals and Practice New YorkThieme Medical2006. 632648

    • Search Google Scholar
    • Export Citation
  • 10

    Fourney DRRhines LDHentschel SJSkibber JMWolinsky JPWeber KL: En bloc resection of primary sacral tumors: classification of surgical approaches and outcome. J Neurosurg Spine 3:1111222005

    • Search Google Scholar
    • Export Citation
  • 11

    Fujita TUeda YKawahara NBaba HTomita K: Local spread of metastatic vertebral tumors. A histologic study. Spine (Phila Pa 1976) 22:190519121997

    • Search Google Scholar
    • Export Citation
  • 12

    Gallia GLSciubba DMBydon ASuk IWolinsky JPGokaslan ZL: Total L-5 spondylectomy and reconstruction of the lumbosacral junction. Technical note. J Neurosurg Spine 7:1031112007

    • Search Google Scholar
    • Export Citation
  • 13

    Gennari LAzzarelli AQuagliuolo V: A posterior approach for the excision of sacral chordoma. J Bone Joint Surg Br 69:5655681987

  • 14

    Guo YPalmer JLShen LKaur GWilley JZhang T: Bowel and bladder continence, wound healing, and functional outcomes in patients who underwent sacrectomy. J Neurosurg Spine 3:1061102005

    • Search Google Scholar
    • Export Citation
  • 15

    Hamdi MGebhart MRecloux P: Internal hemipelvectomy. Eur J Surg Oncol 22:1581611996

  • 16

    Hays RP: Resection of the sacrum for benign giant cell tumor; a case report. Ann Surg 138:1151201953

  • 17

    Junge KKrones CJRosch RFackeldey VSchumpelick V: Mesh reconstruction preventing sacral herniation. Hernia 7:2242262003

  • 18

    Koh PKTan BKHong SWTan MHTay AGSong C: The gluteus maximus muscle flap for reconstruction of sacral chordoma defects. Ann Plast Surg 53:44492004

    • Search Google Scholar
    • Export Citation
  • 19

    Leung PC: Reconstruction of the pelvic ring after tumour resection. Int Orthop 16:1681711992

  • 20

    Localio SAFrancis KCRossano PG: Abdominosacral resection of sacrococcygeal chordoma. Ann Surg 166:3944021967

  • 21

    McLoughlin GSSciubba DMSuk IWitham TBydon AGokaslan ZL: En bloc total sacrectomy performed in a single stage through a posterior approach. Neurosurgery 63:1 Suppl 1ONS115ONS1202008

    • Search Google Scholar
    • Export Citation
  • 22

    Miles WKChang DWKroll SSMiller MJLangstein HNReece GP: Reconstruction of large sacral defects following total sacrectomy. Plast Reconstr Surg 105:238723942000

    • Search Google Scholar
    • Export Citation
  • 23

    Pant RMoreau PIlyas IParamasivan ONYounge D: Pelvic limb-salvage surgery for malignant tumors. Int Orthop 24:3113152001

  • 24

    Roy-Camille RSaillant GHernigou PCisterne JP: [Resection en bloc of the scapulohumeral joint and the upper end of the humerous for tumor (author's translation).]. Rev Chir Orthop Reaparatrice Appar Mot 68:2112141982. (Fr)

    • Search Google Scholar
    • Export Citation
  • 25

    Sakaura HHosono NMukai YIshii TYonenobu KYoshikawa H: Outcome of total en bloc spondylectomy for solitary metastasis of the thoracolumbar spine. J Spinal Disord Tech 17:2973002004

    • Search Google Scholar
    • Export Citation
  • 26

    Schwab JHHealey JHRose PCasas-Ganem JBoland PJ: The surgical management of sacral chordomas. Spine (Phila Pa 1976) 34:270027042009

    • Search Google Scholar
    • Export Citation
  • 27

    Sciubba DMNelson CGok BMcGirt MJMcLoughlin GSNoggle JC: Evaluation of factors associated with postoperative infection following sacral tumor resection. Clinical article. J Neurosurg Spine 9:5935992008

    • Search Google Scholar
    • Export Citation
  • 28

    Speed K: Hemipelvectomy. Ann Surg 95:1671731932

  • 29

    Tomita KKawahara NBaba HTsuchiya HNagata SToribatake Y: Total en bloc spondylectomy for solitary spinal metastases. Int Orthop 18:2912981994

    • Search Google Scholar
    • Export Citation
  • 30

    Tomita KToribatake YKawahara NOhnari HKose H: Total en bloc spondylectomy and circumspinal decompression for solitary spinal metastasis. Paraplegia 32:36461994

    • Search Google Scholar
    • Export Citation
  • 31

    Yamamoto YTakeda NSugihara T: Pelvic ring reconstruction with a vascularized bone flap of femur. Plast Reconstr Surg 100:4154171997

    • Search Google Scholar
    • Export Citation
  • 32

    Yao KCBoriani SGokaslan ZLSundaresan N: En bloc spondylectomy for spinal metastases: a review of techniques. Neurosurg Focus 15:5E62003

    • Search Google Scholar
    • Export Citation
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