Clarke Michelle J, Zadnik Patricia L, Groves Mari L, Dasenbrock Hormuzdiyar H, Sciubba Daniel M, Hsu Wesley, Witham Timothy F, Bydon Ali, Gokaslan Ziya L, Wolinsky Jean-Paul
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;
J Neurosurg Spine. 2014 Sep;21(3):458-67. doi: 10.3171/2014.4.SPINE13482. Epub 2014 Jun 13.
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.
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.
In all 3 cases, an oncologically appropriate surgery and spinopelvic reconstruction were performed through a posterior-only approach.
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.
传统上，半侧骶骨切除术和内侧半骨盆切除术需要前后联合入路。单纯后入路有可能在减少手术并发症的同时完成整块肿瘤切除和脊柱骨盆重建。
作者描述了3例通过单纯后入路进行半侧骶骨和髂骨整块切除以及随后的腰骶部和骨盆环重建的病例。还纳入了另外2例更传统的前后分期手术用于比较。
在所有3例病例中，均通过单纯后入路进行了肿瘤学上合适的手术和脊柱骨盆重建。
中线后入路的优势在于能够进行腰骶部重建，这在肿瘤切除过程中S-1椎体发生医源性破坏的病例中是必要的。
