En bloc hemisacrectomy and internal hemipelvectomy via the posterior approach

Technical note

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  • 1 Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;
  • | 2 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
  • | 3 Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; and
  • | 4 Department of Neurosurgery, Wake Forest Medical Center, Winston-Salem, North Carolina
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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.

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