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Imaging appearances and clinical outcome following sacrectomy and ilio-lumbar reconstruction for sacral neoplasia

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Abstract

Objective

Sacrectomy and ilio-lumbar reconstruction is an uncommonly performed complex surgical procedure for the treatment of sacral neoplasia. There are many challenges in the post-operative period including the potential for tumor recurrence, infection, and construct failure. We present our experience of this patient cohort and describe the complications and imaging appearances that can be encountered during the follow-up period.

Materials and methods

Retrospective review of our Orthopaedic Oncology database was undertaken which has been collected over a 30-year period to identify patients that had undergone sacrectomy and ilio-lumbar reconstruction. Pre and post-operative imaging including radiographs, CT, and MRI was reviewed. These were viewed by two experienced musculoskeletal radiologists with consensus opinion if there was disagreement over the imaging findings. Data regarding patient demographics, tumor type, and dimensions was collected. Serial review of radiographs, CT, and MRI was performed to assess implant position and integrity, strut graft position and union, and for the presence of recurrence within the surgical bed.

Results

Five male and two female patients (mean age 36 years, age range 15–54 years) were treated with this procedure. Histological diagnoses included chordoma, chondrosarcoma, osteosarcoma, and spindle cell sarcoma. Mean maximal tumor size on pre-operative imaging was 10.7 cm (range, 6–16 cm). Post-operative follow-up ranged from 10–46 months. A total of 76 imaging studies were reviewed. Commonly identified complications included vertical rod and cross-connector fracture and screw loosening. Fibula strut graft non-union and fracture was also evident on imaging review. Two patients demonstrated disease recurrence during the follow-up period.

Conclusions

This study demonstrates the spectrum and frequency of complications that can occur following sacrectomy and ilio-lumbar reconstruction for sacral neoplasia.

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References

  1. Shikata J, Yamamuro T, Kotoura Y, Mikawa Y, Iida H, Maetani S. Total sacrectomy and reconstruction for primary tumors. Report of two cases. J Bone Joint Surg Am. 1988;70(1):122–5. Epub 1988/01/01.

    CAS  PubMed  Google Scholar 

  2. Zhang ZY, Fu CF, Yang YX, Wang LQ, Cui Y, Liu Y. Long-term outcomes following en bloc resection for sacral tumor: a retrospective analysis of 93 cases. Orthopedics.34(8):e403-7. Epub 2011/08/06.

  3. Gokaslan ZL, Romsdahl MM, Kroll SS, Walsh GL, Gillis TA, Wildrick DM, et al. Total sacrectomy and Galveston L-rod reconstruction for malignant neoplasms. Technical note. J Neurosurg. 1997;87(5):781–7. Epub 1997/11/05.

    Article  CAS  PubMed  Google Scholar 

  4. Zileli M, Hoscoskun C, Brastianos P, Sabah D. Surgical treatment of primary sacral tumors: complications associated with sacrectomy. Neurosurg Focus. 2003;15(5):E9. Epub 2004/08/25.

    PubMed  Google Scholar 

  5. Bergh P, Kindblom LG, Gunterberg B, Remotti F, Ryd W, Meis-Kindblom JM. Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients. Cancer. 2000;88(9):2122–34. Epub 2000/05/17.

    Article  CAS  PubMed  Google Scholar 

  6. Tis JE, Helgeson M, Lehman RA, Dmitriev AE. A biomechanical comparison of different types of lumbopelvic fixation. Spine (Phila Pa 1976). 2009;34(24):E866–72. Epub 2009/11/17.

    Article  Google Scholar 

  7. Jackson RJ, Gokaslan ZL. Spinal-pelvic fixation in patients with lumbosacral neoplasms. J Neurosurg. 2000;92(1 Suppl):61–70. Epub 2000/01/01.

    CAS  PubMed  Google Scholar 

  8. Doita M, Harada T, Iguchi T, Sumi M, Sha H, Yoshiya S, et al. Total sacrectomy and reconstruction for sacral tumors. Spine (Phila Pa 1976). 2003;28(15):E296–301. Epub 2003/08/05.

    Google Scholar 

  9. Randall RL, Bruckner J, Lloyd C, Pohlman TH, Conrad 3rd EU. Sacral resection and reconstruction for tumors and tumor-like conditions. Orthopedics. 2005;28(3):307–13. Epub 2005/03/26.

    PubMed  Google Scholar 

  10. Kazim SFE SA, Hashmi I, Lakdawala RH. Polyaxial screws for lumbo-iliac fixation after sacral tumor resection: experience with a new technique for an old surgical problem. Int J Surg. 2009;7(6):529–33. Epub 06/09/09.

    Article  Google Scholar 

  11. Newman CB, Keshavarzi S, Aryan HE. En bloc sacrectomy and reconstruction: technique modification for pelvic fixation. Surg Neurol. 2009;72(6):752–6. discussion 6. Epub 2009/08/12.

    Article  PubMed  Google Scholar 

  12. Wuisman P, Lieshout O, Sugihara S, van Dijk M. Total sacrectomy and reconstruction: oncologic and functional outcome. Clin Orthop Relat Res. 2000;381:192–203. Epub 2000/12/29.

    Article  PubMed  Google Scholar 

  13. Spiegel DA, Richardson WJ, Scully SP, Harrelson JM. Long-term survival following total sacrectomy with reconstruction for the treatment of primary osteosarcoma of the sacrum. A case report. J Bone Joint Surg Am. 1999;81(6):848–55. Epub 1999/07/03.

    CAS  PubMed  Google Scholar 

  14. Santi MD, Mitsunaga MM, Lockett JL. Total sacrectomy for a giant sacral schwannoma. A case report. Clin Orthop Relat Res. 1993;294:285–9. Epub 1993/09/01.

    PubMed  Google Scholar 

  15. Ohata N, Ozaki T, Kunisada T, Morimoto Y, Tanaka M, Inoue H. Extended total sacrectomy and reconstruction for sacral tumor. Spine (Phila Pa 1976). 2004;29(6):E123–6. Epub 2004/03/12.

    Article  Google Scholar 

  16. Dickey ID, Hugate Jr RR, Fuchs B, Yaszemski MJ, Sim FH. Reconstruction after total sacrectomy: early experience with a new surgical technique. Clin Orthop Relat Res. 2005;438:42–50. Epub 2005/09/01.

    Article  PubMed  Google Scholar 

  17. Min K, Espinosa N, Bode B, Exner GU. Total sacrectomy and reconstruction with structural allografts for neurofibrosarcoma of the sacrum. A case report. J Bone Joint Surg Am. 2005;87(4):864–9. Epub 2005/04/05.

    Article  PubMed  Google Scholar 

  18. Gallia GL, Suk I, Witham TF, Gearhart SL, Black JH, 3rd, Redett RJ, et al. Lumbopelvic reconstruction after combined L5 spondylectomy and total sacrectomy for en bloc resection of a malignant fibrous histiocytoma. Neurosurgery 67(2):E498-502. Epub 2010/07/21.

    Google Scholar 

  19. Kawahara N, Murakami H, Yoshida A, Sakamoto J, Oda J, Tomita K. Reconstruction after total sacrectomy using a new instrumentation technique: a biomechanical comparison. Spine (Phila Pa 1976). 2003;28(14):1567–72. Epub 2003/07/17.

    Google Scholar 

  20. Lindsey C, Deviren V, Xu Z, Yeh RF, Puttlitz CM. The effects of rod contouring on spinal construct fatigue strength. Spine (Phila Pa 1976). 2006;31(15):1680–7. Epub 2006/07/04.

    Article  Google Scholar 

  21. Bradford DS, Ganjavian S, Antonious D, Winter RB, Lonstein JE, Moe JH. Anterior strut-grafting for the treatment of kyphosis. Review of experience with forty-eight patients. J Bone Joint Surg Am. 1982;64(5):680–90. Epub 1982/06/01.

    CAS  PubMed  Google Scholar 

  22. Hanks SE, Kang JD. Late stress fracture of a well-incorporated autologous fibula strut graft in the cervical spine: a case report. J Spinal Disord Tech. 2004;17(6):526–30. Epub 2004/12/01.

    Article  PubMed  Google Scholar 

  23. Saifuddin A. Musculoskeletal MRI. In: Saifuddin A, editor. United Kingdom: Hodder Arnold; 2008.

  24. Sciubba DM, Nelson C, Gok B, McGirt MJ, McLoughlin GS, Noggle JC, et al. Evaluation of factors associated with postoperative infection following sacral tumor resection. J Neurosurg Spine. 2008;9(6):593–9. Epub 2008/11/28.

    Article  PubMed  Google Scholar 

  25. Gallia GL, Sciubba DM, Bydon A, Suk I, Wolinsky JP, Gokaslan ZL, et al. Total L-5 spondylectomy and reconstruction of the lumbosacral junction. Technical note. J Neurosurg Spine. 2007;7(1):103–11. Epub 2007/07/19.

    Article  PubMed  Google Scholar 

  26. Kamath S, Venkatanarasimha N, Walsh MA, Hughes PM. MRI appearance of muscle denervation. Skeletal Radiol. 2008;37(5):397–404. Epub 2008/03/25.

    Article  CAS  PubMed  Google Scholar 

  27. Garner HW, Kransdorf MJ, Bancroft LW, Peterson JJ, Berquist TH, Murphey MD. Benign and malignant soft-tissue tumors: posttreatment MR imaging. Radiographics. 2009;29(1):119–34. Epub 2009/01/27.

    Article  PubMed  Google Scholar 

  28. Stuckey RM, Marco RA. Chondrosarcoma of the mobile spine and sacrum. Sarcoma.2011:274281. Epub 2011/03/26.

  29. Fuchs B, Hoekzema N, Larson DR, Inwards CY, Sim FH. Osteosarcoma of the pelvis: outcome analysis of surgical treatment. Clin Orthop Relat Res. 2009;467(2):510–8. Epub 2008/10/16.

    Article  PubMed  Google Scholar 

  30. De Schepper AMAP, P.M.; Vanhoenacker, F.M., editor. Imaging of soft tissue tumors. 3 ed: Springer; 2006.

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The authors have no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK

    Marianna Thomas, A. M. Davies & Steven L. J. James

  2. Department of Spinal Surgery, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK

    A. J. Stirling & M. Grainger

  3. Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK

    R. J. Grimer

Authors
  1. Marianna Thomas
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  2. A. M. Davies
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  3. A. J. Stirling
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  6. Steven L. J. James
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Correspondence to Steven L. J. James.

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Thomas, M., Davies, A.M., Stirling, A.J. et al. Imaging appearances and clinical outcome following sacrectomy and ilio-lumbar reconstruction for sacral neoplasia. Skeletal Radiol 43, 179–189 (2014). https://doi.org/10.1007/s00256-013-1762-9

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  • DOI: https://doi.org/10.1007/s00256-013-1762-9

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