Surgical Technique: Iliosacral Reconstruction With Minimal Spinal Instrumentation
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
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.
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).
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.
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.
- Akiyama T, Clark JC, Miki Y, Choong PF. The non-vascularised fibular graft: a simple and successful method of reconstruction of the pelvic ring after internal hemipelvectomy. J Bone Joint Surg Br. 2010;92:999–1005. CrossRef
- Beadel GP, McLaughlin CE, Aljassir F, Turcotte RE, Isler MH, Ferguson P, Griffin AM, Bell RS, Wunder JS. Iliosacral resection for primary bone tumors: is pelvic reconstruction necessary? Clin Orthop Relat Res. 2005;438:22–29. CrossRef
- Burkus JK, Sandhu HS, Gornet MF. Influence of rhBMP-2 on the healing patterns associated with allograft interbody constructs in comparison with autograft. Spine (Phila Pa 1976). 2006;31:775–781.
- Chang DW, Fortin AJ, Oates SD, Lewis VO. Reconstruction of the pelvic ring with vascularized double-strut fibular flap following internal hemipelvectomy. Plast Reconstr Surg. 2008;121:1993–2000. CrossRef
- Davis AM, Wright JG, Williams JI, Bombardier C, Griffin A, Bell RS. Development of a measure of physical function for patients with bone and soft tissue sarcoma. Qual Life Res. 1996;5:508–516. CrossRef
- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213. CrossRef
- Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241–246.
- Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am. 1978;60:731–746.
- Hugate R Jr, Sim FH. Pelvic reconstruction techniques. Orthop Clin North Am. 2006;37:85–97. CrossRef
- Kollender Y, Shabat S, Bickels J, Flusser G, Isakov J, Neuman Y, Cohen I, Weyl-Ben-Arush M, Ramo N, Meller I. Internal hemipelvectomy for bone sarcomas in children and young adults: surgical considerations. Eur J Surg Oncol. 2000;26:398–404. CrossRef
- Nishida J, Shiraishi H, Okada K, Ehara S, Shimamura T. Vascularized iliac bone graft for iliosacral bone defect after tumor excision. Clin Orthop Relat Res. 2006;447:145–151. CrossRef
- O’Connor MI, Sim FH. Salvage of the limb in the treatment of malignant pelvic tumors. J Bone Joint Surg Am. 1989;71:481–494.
- Pring ME, Weber KL, Unni KK, Sim FH. Chondrosarcoma of the pelvis: a review of sixty-four cases. J Bone Joint Surg Am. 2001;83:1630–1642.
- Sabourin M, Biau D, Babinet A, Dumaine V, Tomeno B, Anract P. Surgical management of pelvic primary bone tumors involving the sacroiliac joint. Orthop Traumatol Surg Res. 2009;95:284–292. CrossRef
- Sakuraba M, Kimata Y, Iida H, Beppu Y, Chuman H, Kawai A. Pelvic ring reconstruction with the double-barreled vascularized fibular free flap. Plast Reconstr Surg. 2005;116:1340–1345. CrossRef
- Sherman CE, O’Connor MI, Sim FH. Survival, local recurrence, and function after pelvic limb salvage at 23 to 38 years of follow-up. Clin Orthop Relat Res. 2012;470:712–727. CrossRef
- Simonian PT, Routt ML Jr, Harrington RM, Mayo KA, Tencer AF. Biomechanical simulation of the anteroposterior compression injury of the pelvis: an understanding of instability and fixation. Clin Orthop Relat Res. 1994;309:245–256.
- Sink EL, Beaule PE, Sucato D, Kim YJ, Millis MB, Dayton M, Trousdale RT, Sierra RJ, Zaltz I, Schoenecker P, Monreal A, Clohisy J. Multicenter study of complications following surgical dislocation of the hip. J Bone Joint Surg Am. 2011;93:1132–1136. CrossRef
- Wirbel RJ, Schulte M, Mutschler WE. Surgical treatment of pelvic sarcomas: oncologic and functional outcome. Clin Orthop Relat Res. 2001;390:190–205. CrossRef
- Yajima H, Tamai S. Twin-barrelled vascularized fibular grafting to the pelvis and lower extremity. Clin Orthop Relat Res. 1994;303:178–184.
- Surgical Technique: Iliosacral Reconstruction With Minimal Spinal Instrumentation
Clinical Orthopaedics and Related Research®
Volume 471, Issue 3 , pp 947-955
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors