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Decancellation Sacral Osteotomy in Iliosacral Tumor Resection: A Technique for Precise Sacral Margins

  • Surgical Technique
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

En bloc resection of iliosacral sarcomas is a surgical challenge. There are substantial risks of inadequate margins, local recurrence, and nerve root loss when pelvic sarcomas involve sacral root canals and foramina. The decancellation technique uses principles similar to transpedicle decancellation in spinal deformity correction to perform the sacral osteotomy in iliosacral tumor resection. The technique aims at improving sacral margins and minimizing loss of neural function. We performed a decancellation osteotomy in five patients with sarcomas requiring difficult oblique or sagittal sacral osteotomies and selective root sacrifice. Through laminectomy and without anterior exposure, a precise full-thickness osteotomy of the sacrum was performed without major technique-related morbidities or complications. This was followed by formal pelvic resection and reconstruction. Surgical margins were adequate in all patients and all tumor-free nerve roots were preserved.

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Acknowledgments

I thank Amr Nassef, MD, Associate Professor of Radiology, Cairo University Hospitals, Cairo University, for his valuable contribution to accurate surgical planning.

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Center for Preservation and Transplantation of Musculoskeletal Tissues, Cairo University Hospitals, 47 Iran St Dokki, Giza, Egypt

    Yasser R. Farid MD, PhD

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  1. Yasser R. Farid MD, PhD
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Correspondence to Yasser R. Farid MD, PhD.

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The author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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.

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Farid, Y.R. Decancellation Sacral Osteotomy in Iliosacral Tumor Resection: A Technique for Precise Sacral Margins. Clin Orthop Relat Res 468, 1362–1372 (2010). https://doi.org/10.1007/s11999-009-1031-3

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  • DOI: https://doi.org/10.1007/s11999-009-1031-3

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