Creation of false pedicles and a neo-pelvis for lumbopelvic reconstruction following en bloc resection of an iliosacral chondrosarcoma with lumbar spine extension: Technical note
Journal of neurosurgery. Spine (Impact Factor: 2.38). 01/2014; 20(3). DOI: 10.3171/2013.11.SPINE13211
En bloc resection with negative tumor margins remains the principal treatment option for control or cure of primary pelvic chondrosarcomas, as current adjuvant therapies remain ineffective. Iliosacral chondrosarcomas with involvement of the sciatic notch are sufficiently challenging tumors. However, when there is concomitant lumbar extension requiring resection of the pedicles to maintain negative surgical margins, transpedicular screw fixation is not possible, making reconstruction of the lumbopelvic junction extremely challenging. A patient with an iliosacral chondrosarcoma with lumbar spine extension is presented in this report to illustrate a novel lumbopelvic spinal construct. Following combined external pelvectomy and hemisacrectomy with contralateral L3-5 hemilaminectomy and ipsilateral pediculotomy, bicortical transvertebral body screws were substituted for the missing pedicles, resulting in the creation of "false pedicles," which were further supplemented with an autologous vascularized fibular strut graft from the amputated lower limb and applied to the lateral aspect of the vertebral bodies. The creation of false pedicles allowed for a robust reconstruction of the lumbopelvic junction, including maintaining pelvic ring integrity with a "neo-pelvis", creating a functional load-bearing construct adequate for early mobilization and ambulation. The biomechanical dynamics of this unique construct are also discussed.
- [Show abstract] [Hide abstract]
ABSTRACT: Primary sacral neoplasms that extend superiorly to involve the distal lumbar spine represent complex surgical problems. Treatment options for these patients are often limited to hemicorporectomy. To detail our surgical technique for en bloc resection of a sarcoma involving the L5 vertebral segment and sacrum and the reconstruction of the lumbopelvic junction. A 52-year-old woman presented with intractable pain secondary to a sarcoma involving the L5 vertebral segment and sacrum. She underwent a combined L5 spondylectomy and total sacrectomy for en bloc resection of her neoplasm. A novel lumbopelvic reconstruction technique was used to establish a liaison between the lumbar spine and pelvis. Operative complications included a venous vascular injury and a nonviable myocutaneous flap. Postoperatively, the patient had complete resolution of her pain. Unfortunately, the patient developed metastatic disease and died 5 months after her initial surgical procedure. We describe a patient who underwent a combined L5 spondylectomy and total sacrectomy for en bloc resection of a lumbosacral sarcoma. Additionally, we report a novel technique to reconstruct the lumbopelvic junction. The operative procedures are detailed with the aid of radiographs, intraoperative photographs, and illustrations.Neurosurgery 08/2010; 67(2):E498-502. DOI:10.1227/01.NEU.0000382972.15422.10 · 3.62 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The efficacy of en bloc resection for spinal tumors is unknown because most of the current evidence is provided by small, single-institution clinical series or case reports. To combine all previously published reports of en bloc resection for primary and metastatic spinal tumors, to describe the overall pattern of disease-free survival, and to investigate potentially prognostic factors for recurrence. A complete MEDLINE search for all articles reporting survival data for en bloc resection of spinal tumors was undertaken; 44 articles met inclusion criteria from which 306 eligible patients were identified. There were 229 cases of primary tumors with a mean follow-up of 65.0 months and 77 cases of solitary metastatic tumors with a mean follow-up of 26.5 months. Median time to recurrence was 113 months for the primary group and 24 months for the metastatic group. Disease-free survival rates at 1, 5, and 10 years were 92.6%, 63.2%, and 43.9%, respectively, for the primary group and 61.8%, 37.5%, and 0%, respectively, for the metastatic group; 5-year disease-free survival rates were 58.4% for chordoma and 62.9% for chondrosarcoma. After adjusting for covariates, age, male sex, metastatic tumors, and osteosarcomas were significantly associated with a tumor recurrence. This study provides the largest published series of patients undergoing en bloc resection for spinal tumors. Median time to recurrence reached almost 10 years in patients with primary tumors; however, it was only 2 years in those with isolated metastatic tumors.Neurosurgery 08/2010; 67(2):435-44; discussion 444-5. DOI:10.1227/01.NEU.0000371987.85090.FF · 3.62 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Large population-based studies of malignant primary osseous spinal neoplasms are lacking and are necessary to have sufficient statistical power to determine if various patient-related factors are in fact significant indicators of prognosis. Using a 30-year US national cancer registry (Surveillance, Epidemiology, and End Results [SEER]), we introduce a preoperative grading scale that is associated with survival in patients undergoing surgical resection for malignant primary osseous spinal neoplasms. Large-scale retrospective study. SEER registry. Survival. The SEER registry (1973-2003) was queried to identify adult patients undergoing surgical resection of histologically confirmed primary spinal chordoma, chondrosarcoma, or osteosarcoma via International Classification of Disease for Oncology, Third Edition coding. Variables independently associated with survival were determined via Cox proportional hazards regression analysis for all tumor types. A grading scale comprising these independent survival predictors was then developed and applied to each histology-specific tumor cohort. Three hundred forty-two patients who underwent surgical resection of a malignant primary osseous spinal neoplasm (114 chordoma, 156 chondrosarcoma, and 72 osteosarcoma) were identified. Overall median survival after surgical resection was histology specific (osteosarcoma: 22 months; chordoma: 100 months; and chondrosarcoma: 160 months). Increasing age (years) and increasing tumor invasion (confined to periosteum; invasion through periosteum into adjacent tissues; and distal site metastasis) were the only variables independently associated with decreased survival (p<.05) for all tumor types. For spinal chordoma, sacrum/pelvic location (p<.05) and earlier year of surgery (p<.005) were also independently associated with decreased survival. Using variables of patient age, extent of local tumor invasion, and metastasis status in a five-point grading scale, increasing score (1-5) closely correlated (p<.001) with decreased survival for chordoma, chondrosarcoma, and osteosarcoma. In our analysis of a US population-based cancer registry (SEER), a grading scale consisting of age, metastasis status, and extent of local tumor invasion was associated with overall survival after surgical resection of chordoma, chondrosarcoma, and osteosarcoma of the spine. Although this analysis could not take into account specific chemotherapy regimens and variations in surgical technique, this grading scale may offer valuable prognostic data based on variables available to the surgeon and patient before surgery and may help guide level of aggressiveness in subsequent treatment strategies.The spine journal: official journal of the North American Spine Society 02/2011; 11(3):190-6. DOI:10.1016/j.spinee.2011.01.013 · 2.43 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.