Sacrectomy for sacral tumors: perioperative outcomes in a large-volume comprehensive cancer center

Feghali, James; Pennington, Zach; Hung, Bethany; Hersh, Andrew; Schilling, Andrew; Ehresman, Jeff; Srivastava, Siddhartha; Cottrill, Ethan; Lubelski, Daniel; Lo, Sheng Fu L.; Sciubba, Daniel M.

doi:10.1016/j.spinee.2021.05.004

Cited by 5 publications

(7 citation statements)

References 34 publications

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“…No sacral insufficiency fractures were seen in our patient cohort with median clinical follow-up time of 216 days. Although the rate of insufficiency fracture postsacrectomy in the literature is reported as low as 3.5%, 11 many of these studies are reporting their entire sacrectomy database and do not report the fracture rates solely in patients who did not receive instrumentation. 2,4,[10][11][12][13] Thus, sacral insufficiency fracture may represent a more prominent problem in midsacral amputations where the proximal transverse osteotomy is anywhere from the distal S1 vertebral body to the S2/3 disc space.…”

Section: Discussionmentioning

confidence: 99%

“…Although the rate of insufficiency fracture postsacrectomy in the literature is reported as low as 3.5%, 11 many of these studies are reporting their entire sacrectomy database and do not report the fracture rates solely in patients who did not receive instrumentation. 2,4,[10][11][12][13] Thus, sacral insufficiency fracture may represent a more prominent problem in midsacral amputations where the proximal transverse osteotomy is anywhere from the distal S1 vertebral body to the S2/3 disc space. Sacrectomies with proximal osteotomies involving this "zone of partial stability" (Figure 1) may require further fixation for stabilization.…”

Section: Discussionmentioning

confidence: 99%

“…Our current cohort consists of a subset of patients comparable with a previously reported sacrectomy data set 11 regarding demographics and operative conditions. The median age of 59 is comparable with our historical cohort median age of 55, both with an approximately equal split between male and female patients.…”

Section: Discussionmentioning

confidence: 99%

“…A comparison data set was derived from a previously published article. 11 Patients were identified who underwent sacrectomy where the upper transverse osteotomy was at the level of the distal S1 body down to the S2-3 disc space without concomitant hardware placement. Comparable data were collected, including age, sex, operative characteristics, and presence or absence of sacral insufficiency fracture.…”

Section: Methodsmentioning

confidence: 99%

“…Such potentially destabilizing ligament disruptions may help explain why sacral insufficiency fractures occur in the residual sacrum even after distal or midsacral amputations. 2,4,[10][11][12][13][14] In this study, we present our experience placing pelvic fixation without extension into the lumbar spine. 15 We hypothesize that intrapelvic fixation can maintain intrinsic sacropelvic stability after partial sacrectomies, thus avoiding subsequent sacral insufficiency fractures, while avoiding the morbidity of instrumenting into the mobile lumbar spine.…”

mentioning

confidence: 99%

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Novel Standalone Motion-Sparing Pelvic Fixation Prevents Short-Term Insufficiency Fractures After Midsacrectomies Without Sacrificing Normal, Mobile Lumbar Segments Traditionally Used for Stabilization

Pieters

Hersh

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Sacrectomy is often the treatment of choice to provide the greatest chance of progression-free and overall survival for patients with primary malignant bone tumors of the sacrum. After midsacrectomy, the stability of the sacropelvic interface is diminished, resulting in insufficiency fractures. Traditional stabilization involves lumbopelvic fixation but subjects normal mobile segments to fusion. The purpose of this study was to determine whether standalone intrapelvic fixation is a safe adjunct to midsacrectomy, avoiding both sacral insufficiency fractures and the morbidity of instrumenting into the mobile spine. METHODS: A retrospective study identified all patients who underwent resection of sacral tumors at 2 comprehensive cancer centers between June 2020 and July 2022. Demographic, tumor-specific, operative characteristics and outcome data were collected. The primary outcome was presence of sacral insufficiency fractures. A retrospective data set of patients undergoing midsacrectomy without hardware placement was collected as a control. RESULTS: Nine patients (5 male, 4 female), median age 59 years, underwent midsacrectomy with concomitant placement of standalone pelvic fixation. No patients developed insufficiency fractures during the 216 days of clinical and 207 days of radiographic follow-up. There were no adverse events attributable to the addition of standalone pelvic fixation. In our historical cohort of partial sacrectomies without stabilization, there were 4/25 patients (16%) with sacral insufficiency fractures. These fractures appeared between 0 and 5 months postoperatively. CONCLUSION: A novel standalone intrapelvic fixation after partial sacrectomy is a safe adjunct to prevent postoperative sacral insufficiency fractures in patients undergoing midsacrectomy for tumor. Such a technique may allow for long-term sacropelvic stability without sacrificing mobile lumbar segments.

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