A Novel “Four-Rod Technique” for Lumbo-Pelvic Reconstruction: Theory and Technical Considerations

Shen, Francis H.; Harper, Mark; Foster, William C.; Marks, Ian; Arlet, Vincent

doi:10.1097/01.brs.0000219527.64180.95

Cited by 99 publications

(60 citation statements)

References 50 publications

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“…Although there are various solutions, most authors recommend spinopelvic reconstruction after total or high proximal sacrectomy because of instability associated with complete dissociation of the mobile spine with the pelvis [17,18,28,41,45,55]. However, other surgeons [11,34,46], including us, do not advocate reconstruction of the osseous defect after total sacrectomy because of the risk of major wound complications (especially deep wound infection) and considering the acceptable ambulatory status of patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, other surgeons [11,34,46], including us, do not advocate reconstruction of the osseous defect after total sacrectomy because of the risk of major wound complications (especially deep wound infection) and considering the acceptable ambulatory status of patients. Usually, after total sacrectomy, the lumbar spine migrates inferiorly and remains between the ilia [17,18,45,55]. The muscles and scar between the pelvis and spine form a biologic sling eventually stabilizing the spine.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Margins and Local Control in Resection of Sacral Chordomas

Ruggieri

Angelini

Ussia

et al. 2010

Clinical Orthopaedics &Amp; Related Research

169

152

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Background The treatment of choice in sacral chordoma is surgical resection, although the risk of local recurrence and metastasis remains high. The quality of surgical margins obtained at initial surgery is the primary factor to improve survival reducing the risk of local recurrence, but proximal sacral resections are associated with substantial perioperative morbidity. Questions/purposes We considered survivorship related to local recurrence in terms of surgical margins, level of resection, and previous surgery. Methods We retrospectively reviewed 56 patients with sacral chordomas treated with surgical resection. Thirtyseven were resected above S3 by a combined anterior and posterior approach and 19 at or below S3 by a posterior approach. Nine of these had had previous intralesional surgery elsewhere. The minimum followup was 3 years (mean, 9.5 years; range, 3-28 years). Results Overall survival was 97% at 5 years, 71% at 10 years, and 47% at 15 years. Survivorship to local recurrence was 65% at 5 years and 52% at 10 years. Thirty percent of patients developed metastases. Wide margins were associated with increased survivorship to local recurrence. We found no differences in local recurrence between wide and wide-contaminated margins (that is, if the tumor or its pseudocapsule was exposed intraoperatively, but further tissue was removed to achieve wide margins). Previous intralesional surgery was associated with an increased local recurrence rate. We observed no differences in the recurrence rate in resections above S3 or at and below S3. Conclusions Surgical margins affect the risk of local recurrence. Previous intralesional surgery was associated with a higher rate of local recurrence. Intraoperative contamination did not affect the risk of local recurrence when wide margins were subsequently attained.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical Margins and Local Control in Resection of Sacral Chordomas

Ruggieri

Angelini

Ussia

et al. 2010

Clinical Orthopaedics &Amp; Related Research

169

152

View full text Add to dashboard Cite

show abstract

“…The anatomy of this region, poor quality bone and non-availability of stable anchoring sites frequently place enormous loads at this junction [9]. They include axial, translational and rotational loads, and bending moments [6,10]. The potential for survival of patients over several years demands long-term stability from the reconstruction [14].…”

Section: Historical Reviewmentioning

confidence: 99%

“…Lumbo-pelvic reconstruction is a challenging problem despite the advances in tumour reconstructive surgery [1][2][3][4][5][6][7][8]. The anatomy of this region, poor quality bone and non-availability of stable anchoring sites frequently place enormous loads at this junction [9].…”

Section: Historical Reviewmentioning

confidence: 99%

A novel “pelvic ring augmentation construct” for lumbo-pelvic reconstruction in tumour surgery

et al. 2012

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Aim Reconstructing or augmenting the lumbo-pelvic junction after resection of L5 and part of the sacrum is challenging. Numerous lumbo-pelvic reconstruction methods based on posterior construct and anterior cages have been proposed for cases involving total sacrectomy and lumbar vertebrectomy. These constructs create long lever arms and generate high cantilever forces across the lumbo-sacral junction, resulting in implant failure or breakage. Biomechanical studies have shown that placing implants anterior to lumbo-sacral pivot point provides a more effective moment arm to resist flexion force and improves the ultimate strength of the construct. We present here a novel method to augment a lumbo-pelvic construction using a pelvic ring construct. Methods A 69-year-old lady presented with implant failure of her two previous posterior lumbo-pelvic reconstructions performed by the authors. She initially presented, two and a half years previously with 6 months history of back pain with normal neurological function. MRI scans of her whole spine showed isolated secondaries in the lumbar spine (L4, L5) and sacrum (S1). An abdominal CT scan revealed a primary tumour in her right kidney. Briefly, the first surgery involved a single-stage removal of posterior elements of L4 and L5 and posterior stabilisation from L2 to pelvis, anterior resection of L4 and L5 and partially S1 with implantation of an expandable Synex II cage. The cage was replaced with an anterior rod construct from L2 and L3 to a trans-sacral screw a week later as it had dislodged. The second revision, 9 months later, involved removal of two posterior broken rods which were replaced and converted into a modified four-rod construct. While monitoring her progress, it was subsequently noted that the trans-sacral rod had broken. Therefore, it was decided to augment her lumbo-pelvic construct to prevent eventual catastrophic posterior construct failure. From a posterior approach, contoured rods were passed bilaterally along the inner table of the pelvis under the iliacus muscle up to the anterior border of the pelvis. Using T-connectors, the rods were connected to the posterior lumbo-pelvic construct. Thereafter, two anterior supra-acetabular pelvic screws were connected to a subcutaneously placed rod matched to the shape of the anterior abdominal wall. The pelvic ring construct was completed on connecting this rod with T-connectors to the free ends of the contoured iliac rods.

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“…Because of the complexity and some shortcomings of this former type of fixation we ourselves described several pelvic fixations over the years: the modified Luque for Duchenne's neuromuscular scoliosis, the MW fixation for severe and rigid pelvic obliquity, the adult pelvic fixation and the four-rod techniques for sacrectomy and/or previously failed deformity surgery [2][3][4][5]. Numerous authors have also described other methods of pelvic fixation, the latest using S2 screws to achieve anchor in the sacrum and pelvis [6].…”

mentioning

confidence: 99%

Reviewer’s Comment concerning “Multiaxial high modularity spinopelvis (HSMP) fixation device in neuromuscular scoliosis—a comparative study” (ESJO-D-13-00331R1 by Jin-Ho Hwang, Hitesh N. Modi, Seung-Woo Suh, Jae-Hyuk Yang, Jae-Young Hong)

A Novel “Four-Rod Technique” for Lumbo-Pelvic Reconstruction: Theory and Technical Considerations

Cited by 99 publications

References 50 publications

Surgical Margins and Local Control in Resection of Sacral Chordomas

Surgical Margins and Local Control in Resection of Sacral Chordomas

A novel “pelvic ring augmentation construct” for lumbo-pelvic reconstruction in tumour surgery

Reviewer’s Comment concerning “Multiaxial high modularity spinopelvis (HSMP) fixation device in neuromuscular scoliosis—a comparative study” (ESJO-D-13-00331R1 by Jin-Ho Hwang, Hitesh N. Modi, Seung-Woo Suh, Jae-Hyuk Yang, Jae-Young Hong)

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