Cherry Ahmed, Oitment Colby, Wunder Jay, Ferguson Peter, Rampersaud Raja
University of Toronto, Toronto, ON, Canada.
Hamilton Health Sciences Center, Hamilton, ON, Canada.
Eur Spine J. 2022 Dec;31(12):3759-3767. doi: 10.1007/s00586-022-07363-z. Epub 2022 Sep 3.
Primary sacral tumors are rare, representing fewer than 7% of spinal neoplasms. Following total sacrectomy, lumbopelvic instrumentation and fusion carries a high risk of non-union with no current consensus on fixation techniques to augment bony defects. We aim to describe the outcome of a reconstruction technique following total sacrectomy whereby lumbopelvic shortening is performed and the posterior pelvic ring is compressed to enable contact with the native L5 vertebra.
Retrospective chart review of 2 patients with 2 and 7 years post-operative follow-up. A review of hospital records including clinical assessments, complications, pathology and imaging reports.
Patient 1 was a 17-years-old male with recurrent sacral chondrosarcoma, who presented with lumbosacral neuropathic pain and radiculopathy after failed intralesional surgery. Patient 2 was a 51-years-old male with chronic low back pain caused by a large low-grade chondroid sacral chordoma. Reconstruction technique involved mobilizing the L5 vertebra into the pelvis and pelvic ring closure to obtain host-bone-to-bone contact, eliminating the need for alternative grafts. Post-operative complications included superficial abdominal wound drainage, lower limb DVT, pulmonary emboli and deep pelvic infection. Serial CT scans demonstrated bony fusion in both patients. Neither patients had evidence of tumor recurrence and were able to ambulate at recent follow-up. Imaging demonstrated changed acetabular version of - 4.6/- 8.1 and - 14.4/- 14.8 (patient 1/2, R/L, respectively).
Primary lumbopelvic shortening represents an alternative local autograft reconstructive technique for management of large sacral defects following total sacrectomy. This technique obviates the additional morbidity and surgical cost associated with the use of previously described techniques.
原发性骶骨肿瘤较为罕见，占脊柱肿瘤的比例不到7%。全骶骨切除术后，腰骶骨盆内固定和融合术不愈合风险高，目前对于增加骨缺损固定技术尚无共识。我们旨在描述一种全骶骨切除术后的重建技术的结果，该技术通过进行腰骶骨盆缩短并压缩骨盆后环，以使与L5椎体原位接触。
对2例患者进行回顾性病历审查，术后随访时间分别为2年和7年。审查医院记录，包括临床评估、并发症、病理和影像学报告。
患者1为17岁男性，患有复发性骶骨软骨肉瘤，病灶内手术失败后出现腰骶部神经病理性疼痛和神经根病。患者2为51岁男性，因巨大低度软骨样骶骨脊索瘤导致慢性下腰痛。重建技术包括将L5椎体移入骨盆并闭合骨盆环，以实现宿主骨与骨的接触，无需使用替代移植物。术后并发症包括腹部浅表伤口引流、下肢深静脉血栓形成、肺栓塞和深部盆腔感染。连续CT扫描显示两名患者均有骨融合。两名患者均无肿瘤复发迹象，近期随访时能够行走。影像学显示髋臼旋转角度变化为-4.6/-8.1和-14.4/-14.8（分别为患者1/患者2，右侧/左侧）。
原发性腰骶骨盆缩短术是全骶骨切除术后处理巨大骶骨缺损的一种替代性局部自体移植重建技术。该技术避免了与使用先前描述的技术相关的额外发病率和手术成本。
