Advertisement

Lumbosacral Metastatic Spine Disease

  • Andrew B. Kay
  • Rex A. W. Marco
Chapter

Abstract

The treatment of metastatic disease to the lumbosacral region presents challenges and risks not found in other regions of the spine. Surgical management often requires resection and reconstruction, which may be complicated by complex anatomy and has unique biomechanical features. Although lesions may be resected from an anterior approach, a posterior approach is preferred to avoid critical neurovascular structures. Recommended techniques include a transpedicular resection followed by reconstruction and instrumentation with four total rods and pelvic bolts. This chapter reviews the relevant anatomy and biomechanics of lumbosacral metastatic disease, as well as the authors’ preferred operative technique and perioperative management.

Keywords

Spine Metastatic Cancer Lumbosacral Lumbopelvic Metastasis 

References

  1. 1.
    Cummings BJ, Ian Hodson D, Bush RS. Chordoma: the results of megavoltage radiation therapy. Int J Radiat Oncol Biol Phys. 1983;9(5):633–42.CrossRefPubMedGoogle Scholar
  2. 2.
    Raque GH, Vitaz TW, Shields CB. Treatment of neoplastic diseases of the sacrum. J Surg Oncol. 2001;76(4):301–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Wuisman P, Lieshout O, Sugihara S, van Dijk M. Total sacrectomy and reconstruction: oncologic and functional outcome. Clin Orthopaed Related Res. 2000;381:192–203.CrossRefGoogle Scholar
  4. 4.
    Quraishi NA, Giannoulis KE, Manoharan SR, Edwards KL, Boszczyk BM. Surgical treatment of cauda equina compression as a result of metastatic tumours of the lumbo-sacral junction and sacrum. Eur Spine J. 2013;22(1):33–7.CrossRefGoogle Scholar
  5. 5.
    Llauger J, Palmer J, Amores S, Bague S, Camins A. Primary tumors of the sacrum: diagnostic imaging. Am J Roentgenol. 2000;174(2):417–24.CrossRefGoogle Scholar
  6. 6.
    Fourney DR, Gokaslan ZL. Complex lumbosacral resection and reconstruction procedure. In:Cancer in the spine: Humana Press; 2006. p. 265–77.Google Scholar
  7. 7.
    Gunterberg B, Romanus B, Stener B. Pelvic strength after major amputation of the sacrum: an experimental study. Acta Orthopaed Scand. 1976;47(6):635–42.CrossRefGoogle Scholar
  8. 8.
    Chopin D. A new device for pelvic fixation for spinal surgery: the sacral block. Presented at the 8th International Congresson Cotrel-Dubousset instrumentation. Minneapolis, MN; 1991.Google Scholar
  9. 9.
    D’Ariano GD, Kostuik JP, Carbone JJ. Regional considerations in sacral and iliac fixation techniques. In:Spinal instrumentation. 2nd ed. Philadelphia, PA: Lippincott Williams Wilkins; 1999. p. 291–301.Google Scholar
  10. 10.
    Farcy JP, Rawlins BA, Glassman SD. Technique and results of fixation to the sacrum with iliosacral screws. Spine. 1992;17(6):S190–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Jackson RJ, Gokaslan ZL. Spinal-pelvic fixation in patients with lumbosacral neoplasms. J Neurosurg Spine. 2000;92(1):61–70.CrossRefGoogle Scholar
  12. 12.
    Kuroki H, Tajima N, Kubo S. Instrument failure after total sacrectomy and reconstruction of the sacrum. Nishinihonsekituikenkyukaisi. 1998;24:209–12.Google Scholar
  13. 13.
    Gaines RW. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am. 2000;82(10):1458–76.CrossRefPubMedGoogle Scholar
  14. 14.
    Miles WK, Chang DW, Kroll SS, Miller MJ, Langstein HN, Reece GP, Evans GR, Robb GL. Reconstruction of large sacral defects following total sacrectomy. Plast Reconstruct Surg. 2000;105(7):2387–94.CrossRefGoogle Scholar
  15. 15.
    Pihlajamäki H, Myllynen P, Böstman O. Complications of transpedicular lumbosacral fixation for non-traumatic disorders. Bone Joint J. 1997;79(2):183–9.CrossRefGoogle Scholar
  16. 16.
    Sar C, Eralp L. Surgical treatment of primary tumors of the sacrum. Arch Orthopaed Trauma Surg. 2002;122(3):148–55.CrossRefGoogle Scholar
  17. 17.
    Zhang HY, Thongtrangan I, Balabhadra RS, Murovic JA, Kim DH. Surgical techniques for total sacrectomy and spinopelvic reconstruction. Neurosurg Focus. 2003;15(2):1–0.CrossRefGoogle Scholar
  18. 18.
    Wood KB, DeVine J, Fischer D, Dettori JR, Janssen M. Vascular injury in elective anterior lumbosacral surgery. Spine. 2010;35(9S):S66–75.CrossRefPubMedGoogle Scholar
  19. 19.
    Comer GC, Smith MW, Hurwitz EL, Mitsunaga KA, Kessler R, Carragee EJ. Retrograde ejaculation after anterior lumbar interbody fusion with and without bone morphogenetic protein-2 augmentation: a 10-year cohort controlled study. Spine J. 2012;12(10):881–90.CrossRefPubMedGoogle Scholar
  20. 20.
    Sasso RC, Burkus JK, LeHuec JC. Retrograde ejaculation after anterior lumbar interbody fusion: transperitoneal versus retroperitoneal exposure. Spine. 2003;28(10):1023–6.PubMedGoogle Scholar
  21. 21.
    Bilsky MH, Boland P, Lis E, Raizer JJ, Healey JH. Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine. 2000;25(17):2240–50.CrossRefPubMedGoogle Scholar
  22. 22.
    Jackson RP, McManus AC. The iliac buttress: a computed tomographic study of sacral anatomy. Spine. 1993;18(10):1318–28.CrossRefPubMedGoogle Scholar
  23. 23.
    Renner SM, Lim TH, Kim WJ, Katolik L, An HS, Andersson GB. Augmentation of pedicle screw fixation strength using an injectable calcium phosphate cement as a function of injection timing and method. Spine. 2004;29(11):E212–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Turner AW, Gillies RM, Svehla MJ, Saito M, Walsh WR. Hydroxyapatite composite resin cement augmentation of pedicle screw fixation. Clin Orthopaed Related Res. 2003;406(1):253–61.CrossRefGoogle Scholar
  25. 25.
    Cook SD, Barbera J, Rubi M, Salkeld SL, Whitecloud TS. Lumbosacral fixation using expandable pedicle screws: an alternative in reoperation and osteoporosis. Spine J. 2001;1(2):109–14.CrossRefPubMedGoogle Scholar
  26. 26.
    Shen FH, Harper M, Foster WC, Marks I, Arlet V. A novel “four-rod technique” for lumbo-pelvic reconstruction: theory and technical considerations. Spine. 2006;31(12):1395–401.CrossRefPubMedGoogle Scholar
  27. 27.
    Barber JW, Boden SD, Ganey T, Hutton WC. Biomechanical study of lumbar pedicle screws: does convergence affect axial pullout strength? Clin Spine Surg. 1998;11(3):215–20.Google Scholar
  28. 28.
    Boucher HH. A method of spinal fusion. Bone Joint J. 1959;41(2):248–59.Google Scholar
  29. 29.
    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. 2003;28(14):1567–72.PubMedGoogle Scholar
  30. 30.
    McCord DH, Cunningham BW, Shono Y, Myers JJ, McAfee PC. Biomechanical analysis of lumbosacral fixation. Spine. 1992;17:235–43.CrossRefGoogle Scholar
  31. 31.
    O’Brien MF, Kuklo TR, Lenke LG. Sacropelvic instrumentation: anatomic and biomechanical zones of fixation. Semin Spine Surg. 2004;16(2):76–90.CrossRefGoogle Scholar
  32. 32.
    Tis JE, Helgeson M, Lehman RA, Dmitriev AE. A biomechanical comparison of different types of lumbopelvic fixation. Spine. 2009;34(24):E866–72.CrossRefPubMedGoogle Scholar
  33. 33.
    Lebwohl NH, Cunningham BW, Dmitriev A, Shimamoto N, Gooch L, Devlin V, Boachie-Adjei O, Wagner TA. Biomechanical comparison of lumbosacral fixation techniques in a calf spine model. Spine. 2002;27(21):2312–20.CrossRefPubMedGoogle Scholar
  34. 34.
    Kuklo TR, Bridwell KH, Lewis SJ, Baldus C, Blanke K, Iffrig TM, Lenke LG. Minimum 2-year analysis of sacropelvic fixation and L5–S1 fusion using S1 and iliac screws. Spine. 2001;26(18):1976–83.CrossRefPubMedGoogle Scholar
  35. 35.
    Kebaish KM. Sacropelvic fixation: techniques and complications. Spine. 2010;35(25):2245–51.CrossRefPubMedGoogle Scholar
  36. 36.
    Emami A, Deviren V, Berven S, Smith JA, Hu SS, Bradford DS. Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation. Spine. 2002;27(7):776–86.CrossRefPubMedGoogle Scholar
  37. 37.
    Tsuchiya K, Bridwell KH, Kuklo TR, Lenke LG, Baldus C. Minimum 5-year analysis of L5–S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine. 2006;31(3):303–8.CrossRefPubMedGoogle Scholar
  38. 38.
    O’Brien JR, Warren DY, Bhatnagar R, Sponseller P, Kebaish KM. An anatomic study of the S2 iliac technique for lumbopelvic screw placement. Spine. 2009;34(12):E439–42.CrossRefPubMedGoogle Scholar
  39. 39.
    Chang TL, Sponseller PD, Kebaish KM, Fishman EK. Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation. Spine. 2009;34(5):436–40.CrossRefPubMedGoogle Scholar
  40. 40.
    Stambough JL. Lumbosacral instrumented fusion: analysis of 124 consecutive cases. J Spinal Disord. 1999;12(1):1–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Kelly BP, Shen FH, Schwab JS, Arlet V, Diangelo DJ. Biomechanical testing of a novel four-rod technique for lumbo-pelvic reconstruction. Spine. 2008;33(13):E400–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Moskowitz A. Transforaminal lumbar interbody fusion. Orthoped Clin. 2002;33(2):359–66.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryHouston Methodist HospitalHoustonUSA

Personalised recommendations