Surgical techniques for spinopelvic reconstruction following total sacrectomy

A systematic review

S. Samuel Bederman, Kalpit N. Shah, Jeffrey M. Hassan, Bang H. Hoang, P. Douglas Kiester, Nitin N. Bhatia

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Purpose: To identify all available reconstruction methods for a total sacrectomy. Secondarily, we aimed to evaluate outcomes based on different interventions. Methods: We searched PubMed to identify sacral resections for tumors requiring internal fixation for stabilization. Demographic information, fixation techniques and postoperative outcomes were abstracted. Results: Twenty-three publications (43 patients) met inclusion criteria from an initial search of 856 (κ 0.93). Mean age was 37 years and follow-up was 33 months. Fixation methods included a combination of spinopelvic fixation (SPF), posterior pelvic ring fixation (PPRF), and/or anterior spinal column fixation (ASCF). For the purposes of analysis, patients were segregated based on whether they received ASCF. Postoperative complications including wound/instrument infections, GI or vascular complications were reported at a higher rate in the non-ASCF group (1.63 complications/patient vs. 0.7 complications/patient). Instrument failure was seen in 5 (16.1 %) out of the 31 patients with reported outcomes. Specifically, 1 out of 8 patients (12.5 %) with ASCF compared with 4 out of 23 patients (17.4 %) without ASCF had hardware failure. At final follow-up, 35 of 39 patients were ambulating. Conclusion: While surgical treatment of primary sacral tumors remains a challenge, there have been advances in reconstruction techniques following total sacrectomy. SPF has shifted from intrapelvic rod and hook constructs to pedicle and iliac screw-rod systems for improved rigidity. PPRF and ASCF have adapted for deficiencies in the posterior ring and anterior column. A trend toward a lower rate of hardware failure emerged in the group utilizing anterior spinal column support. Despite a more involved reconstruction with ASCF, surgical complications such as infection rates and blood loss were lower compared to the group without ASCF. While we cannot definitively say one system is superior to the other, based on the data gleaned from this systematic review, it is our opinion that incorporation of ASCF in reconstructing the spinopelvic junction may lead to improved outcomes. However, most importantly, we recommend that the treating surgeon operate on patients requiring a total sacrectomy based on his or her level of comfort, as these cases can be extremely challenging even among experts.

Original languageEnglish (US)
Pages (from-to)305-319
Number of pages15
JournalEuropean Spine Journal
Volume23
Issue number2
DOIs
StatePublished - Feb 2014
Externally publishedYes

Fingerprint

Spine
Wound Infection
PubMed
Blood Vessels
Publications
Neoplasms
Demography
Infection

Keywords

  • Anterior spinal column fixation
  • Posterior pelvic ring fixation
  • Spinopelvic fixation
  • Systematic review
  • Total sacrectomy

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

Surgical techniques for spinopelvic reconstruction following total sacrectomy : A systematic review. / Bederman, S. Samuel; Shah, Kalpit N.; Hassan, Jeffrey M.; Hoang, Bang H.; Kiester, P. Douglas; Bhatia, Nitin N.

In: European Spine Journal, Vol. 23, No. 2, 02.2014, p. 305-319.

Research output: Contribution to journalArticle

Bederman, S. Samuel ; Shah, Kalpit N. ; Hassan, Jeffrey M. ; Hoang, Bang H. ; Kiester, P. Douglas ; Bhatia, Nitin N. / Surgical techniques for spinopelvic reconstruction following total sacrectomy : A systematic review. In: European Spine Journal. 2014 ; Vol. 23, No. 2. pp. 305-319.
@article{23b525af1fe4487d973075c09af8e452,
title = "Surgical techniques for spinopelvic reconstruction following total sacrectomy: A systematic review",
abstract = "Purpose: To identify all available reconstruction methods for a total sacrectomy. Secondarily, we aimed to evaluate outcomes based on different interventions. Methods: We searched PubMed to identify sacral resections for tumors requiring internal fixation for stabilization. Demographic information, fixation techniques and postoperative outcomes were abstracted. Results: Twenty-three publications (43 patients) met inclusion criteria from an initial search of 856 (κ 0.93). Mean age was 37 years and follow-up was 33 months. Fixation methods included a combination of spinopelvic fixation (SPF), posterior pelvic ring fixation (PPRF), and/or anterior spinal column fixation (ASCF). For the purposes of analysis, patients were segregated based on whether they received ASCF. Postoperative complications including wound/instrument infections, GI or vascular complications were reported at a higher rate in the non-ASCF group (1.63 complications/patient vs. 0.7 complications/patient). Instrument failure was seen in 5 (16.1 {\%}) out of the 31 patients with reported outcomes. Specifically, 1 out of 8 patients (12.5 {\%}) with ASCF compared with 4 out of 23 patients (17.4 {\%}) without ASCF had hardware failure. At final follow-up, 35 of 39 patients were ambulating. Conclusion: While surgical treatment of primary sacral tumors remains a challenge, there have been advances in reconstruction techniques following total sacrectomy. SPF has shifted from intrapelvic rod and hook constructs to pedicle and iliac screw-rod systems for improved rigidity. PPRF and ASCF have adapted for deficiencies in the posterior ring and anterior column. A trend toward a lower rate of hardware failure emerged in the group utilizing anterior spinal column support. Despite a more involved reconstruction with ASCF, surgical complications such as infection rates and blood loss were lower compared to the group without ASCF. While we cannot definitively say one system is superior to the other, based on the data gleaned from this systematic review, it is our opinion that incorporation of ASCF in reconstructing the spinopelvic junction may lead to improved outcomes. However, most importantly, we recommend that the treating surgeon operate on patients requiring a total sacrectomy based on his or her level of comfort, as these cases can be extremely challenging even among experts.",
keywords = "Anterior spinal column fixation, Posterior pelvic ring fixation, Spinopelvic fixation, Systematic review, Total sacrectomy",
author = "Bederman, {S. Samuel} and Shah, {Kalpit N.} and Hassan, {Jeffrey M.} and Hoang, {Bang H.} and Kiester, {P. Douglas} and Bhatia, {Nitin N.}",
year = "2014",
month = "2",
doi = "10.1007/s00586-013-3075-z",
language = "English (US)",
volume = "23",
pages = "305--319",
journal = "European Spine Journal",
issn = "0940-6719",
publisher = "Springer Verlag",
number = "2",

}

TY - JOUR

T1 - Surgical techniques for spinopelvic reconstruction following total sacrectomy

T2 - A systematic review

AU - Bederman, S. Samuel

AU - Shah, Kalpit N.

AU - Hassan, Jeffrey M.

AU - Hoang, Bang H.

AU - Kiester, P. Douglas

AU - Bhatia, Nitin N.

PY - 2014/2

Y1 - 2014/2

N2 - Purpose: To identify all available reconstruction methods for a total sacrectomy. Secondarily, we aimed to evaluate outcomes based on different interventions. Methods: We searched PubMed to identify sacral resections for tumors requiring internal fixation for stabilization. Demographic information, fixation techniques and postoperative outcomes were abstracted. Results: Twenty-three publications (43 patients) met inclusion criteria from an initial search of 856 (κ 0.93). Mean age was 37 years and follow-up was 33 months. Fixation methods included a combination of spinopelvic fixation (SPF), posterior pelvic ring fixation (PPRF), and/or anterior spinal column fixation (ASCF). For the purposes of analysis, patients were segregated based on whether they received ASCF. Postoperative complications including wound/instrument infections, GI or vascular complications were reported at a higher rate in the non-ASCF group (1.63 complications/patient vs. 0.7 complications/patient). Instrument failure was seen in 5 (16.1 %) out of the 31 patients with reported outcomes. Specifically, 1 out of 8 patients (12.5 %) with ASCF compared with 4 out of 23 patients (17.4 %) without ASCF had hardware failure. At final follow-up, 35 of 39 patients were ambulating. Conclusion: While surgical treatment of primary sacral tumors remains a challenge, there have been advances in reconstruction techniques following total sacrectomy. SPF has shifted from intrapelvic rod and hook constructs to pedicle and iliac screw-rod systems for improved rigidity. PPRF and ASCF have adapted for deficiencies in the posterior ring and anterior column. A trend toward a lower rate of hardware failure emerged in the group utilizing anterior spinal column support. Despite a more involved reconstruction with ASCF, surgical complications such as infection rates and blood loss were lower compared to the group without ASCF. While we cannot definitively say one system is superior to the other, based on the data gleaned from this systematic review, it is our opinion that incorporation of ASCF in reconstructing the spinopelvic junction may lead to improved outcomes. However, most importantly, we recommend that the treating surgeon operate on patients requiring a total sacrectomy based on his or her level of comfort, as these cases can be extremely challenging even among experts.

AB - Purpose: To identify all available reconstruction methods for a total sacrectomy. Secondarily, we aimed to evaluate outcomes based on different interventions. Methods: We searched PubMed to identify sacral resections for tumors requiring internal fixation for stabilization. Demographic information, fixation techniques and postoperative outcomes were abstracted. Results: Twenty-three publications (43 patients) met inclusion criteria from an initial search of 856 (κ 0.93). Mean age was 37 years and follow-up was 33 months. Fixation methods included a combination of spinopelvic fixation (SPF), posterior pelvic ring fixation (PPRF), and/or anterior spinal column fixation (ASCF). For the purposes of analysis, patients were segregated based on whether they received ASCF. Postoperative complications including wound/instrument infections, GI or vascular complications were reported at a higher rate in the non-ASCF group (1.63 complications/patient vs. 0.7 complications/patient). Instrument failure was seen in 5 (16.1 %) out of the 31 patients with reported outcomes. Specifically, 1 out of 8 patients (12.5 %) with ASCF compared with 4 out of 23 patients (17.4 %) without ASCF had hardware failure. At final follow-up, 35 of 39 patients were ambulating. Conclusion: While surgical treatment of primary sacral tumors remains a challenge, there have been advances in reconstruction techniques following total sacrectomy. SPF has shifted from intrapelvic rod and hook constructs to pedicle and iliac screw-rod systems for improved rigidity. PPRF and ASCF have adapted for deficiencies in the posterior ring and anterior column. A trend toward a lower rate of hardware failure emerged in the group utilizing anterior spinal column support. Despite a more involved reconstruction with ASCF, surgical complications such as infection rates and blood loss were lower compared to the group without ASCF. While we cannot definitively say one system is superior to the other, based on the data gleaned from this systematic review, it is our opinion that incorporation of ASCF in reconstructing the spinopelvic junction may lead to improved outcomes. However, most importantly, we recommend that the treating surgeon operate on patients requiring a total sacrectomy based on his or her level of comfort, as these cases can be extremely challenging even among experts.

KW - Anterior spinal column fixation

KW - Posterior pelvic ring fixation

KW - Spinopelvic fixation

KW - Systematic review

KW - Total sacrectomy

UR - http://www.scopus.com/inward/record.url?scp=84893846688&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84893846688&partnerID=8YFLogxK

U2 - 10.1007/s00586-013-3075-z

DO - 10.1007/s00586-013-3075-z

M3 - Article

VL - 23

SP - 305

EP - 319

JO - European Spine Journal

JF - European Spine Journal

SN - 0940-6719

IS - 2

ER -