Zoccali Carmine, Skoch Jesse, Patel Apar S, Walter Christina M, Maykowski Philip, Baaj Ali A
Oncological Orthopaedics Department, Muscular-skeletal Tissue Bank, IFO - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
Division of Neurosurgery, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA.
Eur Spine J. 2016 Dec;25(12):3925-3931. doi: 10.1007/s00586-016-4450-3. Epub 2016 Feb 25.
Sacrectomy is a highly demanding surgery representing the main treatment for primary tumors arising in the sacrum and pelvis. Unfortunately, it is correlated with loss of important function depending on the resection level and nerve roots sacrificed. The current literature regarding residual function after sacral resection comes from several small case series. The goal of this review is to appraise residual motor function and gait, sensitivity, bladder, bowel, and sexual function after sacrectomies, with consideration to the specific roots sacrificed.
An exhaustive literature search was conducted. All manuscripts published before May 2015 regarding residual function after sacrectomy were considered; if a clear correlation between root level and functioning was not present, the paper was excluded. The review identified 15 retrospective case series, totaling 244 patients; 42 patients underwent sacrectomies sparing L4/L4, L4/L5 and L5/L5; 45 sparing both L5 and one or both S1 roots; 8 sparing both S1 and one S2; 48 sparing both S2; 11 sparing both S2 and one S3, 54 sparing both S3, 9 sparing both S3 and one or both S4, and 27 underwent unilateral variable resection.
Patients who underwent a sacrectomy maintained functionally normal ambulation in 56.2 % of cases when both S2 roots were spared, 94.1 % when both S3 were spared, and in 100 % of more distal resections. Normal bladder and bowel function were not present when both S2 were cut. When one S2 root was spared, normal bladder function was present in 25 % of cases; when both S2 were spared, 39.9 %; when one S3 was spared, 72.7 %; and when both S3 were spared, 83.3 %. Abnormal bowel function was present in 12.5 % of cases when both S1 and one S2 were spared; in 50.0 % of cases when both S2 were spared; and in 70 % of cases when one S3 was spared; if both S3 were spared, bowel function was normal in 94 % of cases. When even one S4 root was spared, normal bladder and bowel function were present in 100 % of cases. Unilateral sacral nerve root resection preserved normal bladder function in 75 % of cases and normal bowel function in 82.6 % of cases. Motor function depended on S1 root involvement.
Total sacrectomy is associated with compromising important motor, bladder, bowel, sensitivity, and sexual function. Residual motor function is dependent on sparing L5 and S1 nerve roots. Bladder and bowel function is consistently compromised in higher sacrectomies; nevertheless, the probability of maintaining sufficient function increases progressively with the roots spared, especially when S3 nerve roots are spared. Unilateral resection is usually associated with more normal function. To the best of our knowledge, this is the first comprehensive literature review to analyze published reports of residual sacral nerve root function after sacrectomy.
骶骨切除术是一项要求极高的手术，是骶骨和骨盆原发性肿瘤的主要治疗方法。不幸的是，根据切除水平和牺牲的神经根不同，该手术会导致重要功能丧失。目前关于骶骨切除术后残余功能的文献来自几个小病例系列。本综述的目的是评估骶骨切除术后的残余运动功能、步态、感觉、膀胱、肠道和性功能，并考虑所牺牲的特定神经根。
进行了全面的文献检索。纳入所有2015年5月之前发表的关于骶骨切除术后残余功能的手稿；如果神经根水平与功能之间不存在明确的相关性，则排除该论文。该综述确定了15个回顾性病例系列，共244例患者；42例患者进行了保留L4/L4、L4/L5和L5/L5的骶骨切除术；45例保留L5和一个或两个S1神经根；8例保留S1和一个S[2]；48例保留两个S2；11例保留S2和一个S3；54例保留两个S3；9例保留S3和一个或两个S4；27例进行了单侧可变切除。
当保留两个S2神经根时，56.2%的病例骶骨切除术后患者的行走功能正常；当保留两个S3神经根时，94.1%的病例正常；在更低位的切除病例中，100%的病例正常。当两个S2神经根均被切断时，膀胱和肠道功能不正常。当保留一个S2神经根时，25%的病例膀胱功能正常；当保留两个S2神经根时，39.9%的病例正常；当保留一个S3神经根时，72.7%的病例正常；当保留两个S3神经根时，83.3%的病例正常。当保留S1和一个S2神经根时，12.5%的病例肠道功能异常；当保留两个S2神经根时，50.0%的病例异常；当保留一个S3神经根时，70%的病例异常；当保留两个S3神经根时，94%的病例肠道功能正常。当至少保留一个S4神经根时，100%的病例膀胱和肠道功能正常。单侧骶神经根切除在75%的病例中保留了正常膀胱功能，在82.6%的病例中保留了正常肠道功能。运动功能取决于S1神经根的受累情况。
全骶骨切除术会损害重要的运动、膀胱、肠道、感觉和性功能。残余运动功能取决于保留L5和S1神经根。在高位骶骨切除术中，膀胱和肠道功能持续受损；然而，随着保留的神经根增多，维持足够功能的可能性逐渐增加，尤其是当保留S3神经根时。单侧切除通常与更正常的功能相关。据我们所知，这是第一篇综合文献综述，分析了骶骨切除术后骶神经根残余功能的已发表报告。
