, Volume 471, Issue 3, pp 947-955

Surgical Technique: Iliosacral Reconstruction With Minimal Spinal Instrumentation

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Topic
Tumor

Abstract

Background

Posterior pelvic ring reconstruction can be challenging and controversial. The choice regarding whether to reconstruct and how to reconstitute the pelvic ring is unclear. Many methods provide stability but often are technically difficult and require excessive dissection.

Description of Surgical Technique

This unique reconstructive technique uses the anterior aspect of the iliac crest with its attached muscle pedicle to provide a biologic scaffold for healing. The construct is secured with pedicle screws into the posterior column and S1 vertebral body with a spinal rod locked in compression. No additional fixation is used proximally into the lumbar spine. The iliac crest remains attached to the gluteus medius, allowing potential abductor function.

Methods

We retrospectively reviewed six patients who underwent iliosacral resection with this reconstruction. The mean age of the patients was 41 years. Complications were recorded. One patient died 6 months postoperatively. Musculoskeletal Tumor Society 1993 (MSTS ’93) score and Toronto Extremity Salvage Score (TESS) were obtained at a minimum 1-year followup in five patients. Healing was assessed radiographically. The minimum followup was 6 months (median, 33 months; range, 6–53 months).

Results

The mean MSTS ’93 score was 72% and mean TESS was 66. All posterior column graft sites healed. At last followup, four of the five surviving patients had a stable pseudarthrosis at the proximal sacral site. One patient had a local recurrence and experienced failure of instrumentation without collapse or rotation of the hemipelvis 3 years postoperatively.

Conclusions

This technique provides a simple way to reconstruct the pelvic ring after iliosacral resection with clinical outcomes comparable to those for other methods. The method is a potential alternative for reconstruction of the posterior pelvic ring after resecting the ilium although reliable healing of the sacral site needs to be improved.

One of the authors (JMB) certifies that he has or may receive payments or benefits, during the study period, an amount in excess of $10,000–$100,000, from Stryker, Inc (Mahwah, NJ, USA), CoreLink, Inc (St Louis, MO, USA), Globus Medical, Inc (Audubon, PA, USA), DePuy, Inc (Warsaw, IN, USA), K2M, Inc (Leesburg, VA, USA), One of the authors (DJM) certifies that he has or may receive payments or benefits, during the study period, an amount in excess of less than $10,000, from Stryker, Inc (Mahwah, NJ, USA) and Smith and Nephew, Inc (Memphis, TN, USA). The institution of one of the authors (JMB) has received funding from Complex Spine Study Group/K2M, Inc (Leesburg, VA, USA).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.