Development and current situation of reconstruction methods following total sacrectomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Siyi , JI Tao ,  GUO Wei

Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, 100044, P.R.China;

Corresponding author：

GUO Wei, Email: bonetumor@163.com

Keywords：

Sacral tumor; total sacrectomy; lumbosacral reconstruction

DOI：

10.7507/1002-1892.201712054

Video：

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Objective To review the development of the reconstruction methods following total sacrectomy, and to provide reference for finding a better reconstruction method following total sacrectomy. Methods The case reports and biomechanical and finite element studies of reconstruction following total sacrectomy at home and abroad were searched. Development and current situation were summarized. Results After developing for nearly 30 years, great progress has been made in the reconstruction concept and fixation techniques. The fixation methods can be summarized as the following three strategies: spinopelvic fixation (SPF), posterior pelvic ring fixation (PPRF), and anterior spinal column fixation (ASCF). SPF has undergone technical progress from intrapelvic rod and hook constructs to pedicle and iliac screw-rod systems. PPRF and ASCF could improve the stability of the reconstruction system. Conclusion Reconstruction following total sacrectomy remains a challenge. Reconstruction combining SPF, PPRF, and ASCF is the developmental direction to achieve mechanical stability. How to gain biological fixation to improve the long-term stability is an urgent problem to be solved.

Citation： HUANG Siyi, JI Tao, GUO Wei. Development and current situation of reconstruction methods following total sacrectomy. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(5): 513-518. doi: 10.7507/1002-1892.201712054 Copy

1.	Gunterberg B, Romanus B, Stener B. Pelvic strength after major amputation of the sacrum. An exerimental study. Acta Orthop Scand, 1976, 47(6): 635-642.
2.	Hugate RR Jr, Dickey ID, Phimolsarnti R, et al. Mechanical effects of partial sacrectomy: when is reconstruction necessary? Clin Orthop Relat Res, 2006, 450: 82-88.
3.	Yu B, Zheng Z, Zhuang X, et al. Biomechanical effects of transverse partial sacrectomy on the sacroiliac joints: an in vitro human cadaveric investigation of the borderline of sacroiliac joint instability. Spine (Phila Pa 1976), 2009, 34(13): 1370-1375.
4.	Simpson AH, Porter A, Davis A, et al. Cephalad sacral resection with a combined extended ilioinguinal and posterior approach. J Bone Joint Surg (Am), 1995, 77(3): 405-411.
5.	Shikata J, Yamamuro T, Kotouya Y, et al. Total sacrectomy and reconstruction for primary tumors. Report of two cases. J Bone Joint Surg (Am), 1988, 70(1): 122-125.
6.	Shikata J, Yamamuro T, Shimizu K, et al. Surgical treatment of giant-cell tumors of the spine. Clin Orthop Relat Res, 1992, (278): 29-36.
7.	Tomita K, Tsuchiya H. Total sacrectomy and reconstruction for huge sacral tumors. Spine (Phila Pa 1976), 1990, 15(11): 1223-1227.
8.	Santi MD, Mitsunaga MM, Lockett JL. Total sacrectomy for a giant sacral schwannoma. A case report. Clin Orthop Relat Res, 1993, (294): 285-289.
9.	Blatter G, Halter Ward EG, Ruflin G, et al. The problem of stabilization after sacrectomy. Arch Orthop Trauma Surg, 1994, 114(1): 40-42.
10.	Kawahara N, Murakami H, Yoshida A, et al. Reconstruction after total sacrectomy using a new instrumentation technique: a biomechanical comparison. Spine (Phila Pa 1976), 2003, 28(14): 1567-1572.
11.	Allen BL Jr, Ferguson RL. The Galveston technique for L rod instrumentation of the scoliotic spine. Spine (Phila Pa 1976), 1982, 7(3): 276-284.
12.	Gokaslan ZL, Romsdahl MM, Kroll SS, et al. Total sacrectomy and Galveston L-rod reconstruction for malignant neoplasms. Technical note. J Neurosurg, 1997, 87(5): 781-787.
13.	Sar C, Eralp L. Surgical treatment of primary tumors of the sacrum. Arch Orthop Trauma Surg, 2002, 122(3): 148-155.
14.	Jackson RJ, Gokaslan ZL. Spinal-pelvic fixation in patients with lumbosacral neoplasms. J Neurosurg, 2000, 92(1 Suppl): 61-70.
15.	Doita M, Harada T, Iguchi T, et al. Total sacrectomy and reconstruction for sacral tumors. Spine (Phila Pa 1976), 2003, 28(15): E296-301.
16.	Zhang HY, Thongtrangan I, Balabhadra RS, et al. Surgical techniques for total sacrectomy and spinopelvic reconstruction. Neurosurg Focus, 2003, 15(2): E5.
17.	Ohata N, Ozaki T, Kunisada T, et al. Extended total sacrectomy and reconstruction for sacral tumor. Spine (Phila Pa 1976), 2004, 29(6): E123-126.
18.	Dickey ID, Hugate RR Jr, Fuchs B, et al. Reconstruction after total sacrectomy: early experience with a new surgical technique. Clin Orthop Relat Res, 2005, 438: 42-50.
19.	Fourney DR, Rhines LD, Hentschel SJ, et al. En bloc resection of primary sacral tumors: classification of surgical approaches and outcome. J Neurosurg Spine, 2005, 3(2): 111-122.
20.	Gallia GL, Haque R, Garonzik I, et al. Spinal pelvic reconstruction after total sacrectomy for en bloc resection of a giant sacral chordoma. Technical note. J Neurosurg Spine, 2005, 3(6): 501-506.
21.	McLoughlin GS, Sciubba DM, Suk I, et al. En bloc total sacrectomy performed in a single stage through a posterior approach. Neurosurgery, 2008, 63(1 Suppl 1): ONS115-120.
22.	Newman CB, Keshavarzi S, Aryan HE. En bloc sacrectomy and reconstruction: technique modification for pelvic fixation. Surg Neurol, 2009, 72(6): 752-756.
23.	Shen FH, Harper M, Foster WC, et al. A novel " four-rod technique” for lumbo-pelvic reconstruction: theory and technical considerations. Spine (Phila Pa 1976), 2006, 31(12): 1395-1401.
24.	Kelly BP, Shen FH, Schiwab JS, et al. Biomechanical testing of a novel four-rod technique for lumbo-pelvic reconstruction. Spine (Phila Pa 1976), 2008, 33(13): E400-406.
25.	Dick JC, Zdeblick TA, Bartel BD, et al. Mechanical evaluation of cross-link designs in rigid pedicle screw systems. Spine (Phila Pa 1976), 1997, 22(4): 370-375.
26.	Brodke DS, Bachus KN, Mohr RA, et al. Segmental pedicle screw fixation or cross-links in multilevel lumbar constructs. a biomechanical analysis. Spine J, 2001, 1(5): 373-379.
27.	Yu BS, Zhuang XM, Zheng ZM, et al. Biomechanical advantages of dual over single iliac screws in lumbo-iliac fixation construct. Eur Spine J, 2010, 19(7): 1121-1128.
28.	Macki M, De la Garza-Ramos R, Murgatroyd AA, et al. Comprehensive biomechanical analysis of three reconstruction techniques following total sacrectomy: an in vitro human cadaveric model. J Neurosurg Spine, 2017, 27(5): 570-577.
29.	Bederman SS, Shah KN, Hassan JM, et al. Surgical techniques for spinopelvic reconstruction following total sacrectomy: a systematic review. Eur Spine J, 2014, 23(2): 305-319.
30.	Salehi SA, McCafferty RR, Karahalios D, et al. Neural function preservation and early mobilization after resection of metastatic sacral tumors and lumbosacropelvic junction reconstruction. Report of three cases. J Neurosurg, 2002, 97(1 Suppl): 88-93.
31.	Varga PP, Bors I, Lazary A. Sacral tumors and management. Orthop Clin North Am, 2009, 40(1): 105-123, vii.
32.	Varga PP, Lazary A. Chordoma of the sacrum: " en bloc” total sacrectomy and lumbopelvic reconstruction. Eur Spine J, 2010, 19(6): 1039-1040.
33.	Humphries WE 3rd, Satyan KB, Relyea K, et al. Low-grade myofibroblastic sarcoma of the sacrum. J Neurosurg Pediatr, 2010, 6(3): 286-290.
34.	Gallia GL, Suk I, Witham TF, et al. Lumbopelvic reconstruction after combined L5 spondylectomy and total sacrectomy for en bloc resection of a malignant fibrous histiocytoma. Neurosurgery, 2010, 67(2): E498-502.
35.	姬涛, 郭卫, 杨荣利, 等. 高位骶骨肿瘤切除内固定术后内置物断裂原因分析. 中国脊柱脊髓杂志, 2015, 25(1): 39-44.
36.	Clark AJ, Tang JA, Leasure JM, et al. Gait-simulating fatigue loading analysis and sagittal alignment failure of spinal pelvic reconstruction after total sacrectomy: comparison of 3 techniques. J Neurosurg Spine, 2014, 20(4): 364-370.
37.	Cheng L, Yu Y, Zhu R, et al. Structural stability of different reconstruction techniques following total sacrectomy: a biomechanical study. Clin Biomech (Bristol, Avon), 2011, 26(10): 977-981.
38.	Zhu R, Cheng LM, Yu Y, et al. Comparison of four reconstruction methods after total sacrectomy: a finite element study. Clin Biomech (Bristol, Avon), 2012, 27(8): 771-776.
39.	Yu Y, Zhu R, Zeng ZL, et al. The strain at bone-implant interface determines the effect of spinopelvic reconstruction following total sacrectomy: a strain gauge analysis in various spinopelvic constructs. PLoS One, 2014, 9(1): e85298.
40.	Wuisman P, Lieshout O, van Dijk M, et al. Reconstruction after total en bloc sacrectomy for osteosarcoma using a custom-made prosthesis: a technical note. Spine (Phila Pa 1976), 2001, 26(4): 431-439.
41.	Wuisman P, Lieshout O, Sugihara S, et al. Total sacrectomy and reconstruction: oncologic and functional outcome. Clin Orthop Relat Res, 2000, (381): 192-203.
42.	Wei R, Guo W, Ji T, et al. One-step reconstruction with a 3D-printed, custom-made prosthesis after total en bloc sacrectomy: a technical note. Eur Spine J, 2017, 26(7): 1902-1909.
43.	肖建如, 贾连顺, 陈华江, 等. 高位骶骨肿瘤切除与重建方式探讨. 中华外科杂志, 2003, 41(8): 575-577.

1. Gunterberg B, Romanus B, Stener B. Pelvic strength after major amputation of the sacrum. An exerimental study. Acta Orthop Scand, 1976, 47(6): 635-642.
2. Hugate RR Jr, Dickey ID, Phimolsarnti R, et al. Mechanical effects of partial sacrectomy: when is reconstruction necessary? Clin Orthop Relat Res, 2006, 450: 82-88.
3. Yu B, Zheng Z, Zhuang X, et al. Biomechanical effects of transverse partial sacrectomy on the sacroiliac joints: an in vitro human cadaveric investigation of the borderline of sacroiliac joint instability. Spine (Phila Pa 1976), 2009, 34(13): 1370-1375.
4. Simpson AH, Porter A, Davis A, et al. Cephalad sacral resection with a combined extended ilioinguinal and posterior approach. J Bone Joint Surg (Am), 1995, 77(3): 405-411.
5. Shikata J, Yamamuro T, Kotouya Y, et al. Total sacrectomy and reconstruction for primary tumors. Report of two cases. J Bone Joint Surg (Am), 1988, 70(1): 122-125.
6. Shikata J, Yamamuro T, Shimizu K, et al. Surgical treatment of giant-cell tumors of the spine. Clin Orthop Relat Res, 1992, (278): 29-36.
7. Tomita K, Tsuchiya H. Total sacrectomy and reconstruction for huge sacral tumors. Spine (Phila Pa 1976), 1990, 15(11): 1223-1227.
8. Santi MD, Mitsunaga MM, Lockett JL. Total sacrectomy for a giant sacral schwannoma. A case report. Clin Orthop Relat Res, 1993, (294): 285-289.
9. Blatter G, Halter Ward EG, Ruflin G, et al. The problem of stabilization after sacrectomy. Arch Orthop Trauma Surg, 1994, 114(1): 40-42.
10. Kawahara N, Murakami H, Yoshida A, et al. Reconstruction after total sacrectomy using a new instrumentation technique: a biomechanical comparison. Spine (Phila Pa 1976), 2003, 28(14): 1567-1572.
11. Allen BL Jr, Ferguson RL. The Galveston technique for L rod instrumentation of the scoliotic spine. Spine (Phila Pa 1976), 1982, 7(3): 276-284.
12. Gokaslan ZL, Romsdahl MM, Kroll SS, et al. Total sacrectomy and Galveston L-rod reconstruction for malignant neoplasms. Technical note. J Neurosurg, 1997, 87(5): 781-787.
13. Sar C, Eralp L. Surgical treatment of primary tumors of the sacrum. Arch Orthop Trauma Surg, 2002, 122(3): 148-155.
14. Jackson RJ, Gokaslan ZL. Spinal-pelvic fixation in patients with lumbosacral neoplasms. J Neurosurg, 2000, 92(1 Suppl): 61-70.
15. Doita M, Harada T, Iguchi T, et al. Total sacrectomy and reconstruction for sacral tumors. Spine (Phila Pa 1976), 2003, 28(15): E296-301.
16. Zhang HY, Thongtrangan I, Balabhadra RS, et al. Surgical techniques for total sacrectomy and spinopelvic reconstruction. Neurosurg Focus, 2003, 15(2): E5.
17. Ohata N, Ozaki T, Kunisada T, et al. Extended total sacrectomy and reconstruction for sacral tumor. Spine (Phila Pa 1976), 2004, 29(6): E123-126.
18. Dickey ID, Hugate RR Jr, Fuchs B, et al. Reconstruction after total sacrectomy: early experience with a new surgical technique. Clin Orthop Relat Res, 2005, 438: 42-50.
19. Fourney DR, Rhines LD, Hentschel SJ, et al. En bloc resection of primary sacral tumors: classification of surgical approaches and outcome. J Neurosurg Spine, 2005, 3(2): 111-122.
20. Gallia GL, Haque R, Garonzik I, et al. Spinal pelvic reconstruction after total sacrectomy for en bloc resection of a giant sacral chordoma. Technical note. J Neurosurg Spine, 2005, 3(6): 501-506.
21. McLoughlin GS, Sciubba DM, Suk I, et al. En bloc total sacrectomy performed in a single stage through a posterior approach. Neurosurgery, 2008, 63(1 Suppl 1): ONS115-120.
22. Newman CB, Keshavarzi S, Aryan HE. En bloc sacrectomy and reconstruction: technique modification for pelvic fixation. Surg Neurol, 2009, 72(6): 752-756.
23. Shen FH, Harper M, Foster WC, et al. A novel " four-rod technique” for lumbo-pelvic reconstruction: theory and technical considerations. Spine (Phila Pa 1976), 2006, 31(12): 1395-1401.
24. Kelly BP, Shen FH, Schiwab JS, et al. Biomechanical testing of a novel four-rod technique for lumbo-pelvic reconstruction. Spine (Phila Pa 1976), 2008, 33(13): E400-406.
25. Dick JC, Zdeblick TA, Bartel BD, et al. Mechanical evaluation of cross-link designs in rigid pedicle screw systems. Spine (Phila Pa 1976), 1997, 22(4): 370-375.
26. Brodke DS, Bachus KN, Mohr RA, et al. Segmental pedicle screw fixation or cross-links in multilevel lumbar constructs. a biomechanical analysis. Spine J, 2001, 1(5): 373-379.
27. Yu BS, Zhuang XM, Zheng ZM, et al. Biomechanical advantages of dual over single iliac screws in lumbo-iliac fixation construct. Eur Spine J, 2010, 19(7): 1121-1128.
28. Macki M, De la Garza-Ramos R, Murgatroyd AA, et al. Comprehensive biomechanical analysis of three reconstruction techniques following total sacrectomy: an in vitro human cadaveric model. J Neurosurg Spine, 2017, 27(5): 570-577.
29. Bederman SS, Shah KN, Hassan JM, et al. Surgical techniques for spinopelvic reconstruction following total sacrectomy: a systematic review. Eur Spine J, 2014, 23(2): 305-319.
30. Salehi SA, McCafferty RR, Karahalios D, et al. Neural function preservation and early mobilization after resection of metastatic sacral tumors and lumbosacropelvic junction reconstruction. Report of three cases. J Neurosurg, 2002, 97(1 Suppl): 88-93.
31. Varga PP, Bors I, Lazary A. Sacral tumors and management. Orthop Clin North Am, 2009, 40(1): 105-123, vii.
32. Varga PP, Lazary A. Chordoma of the sacrum: " en bloc” total sacrectomy and lumbopelvic reconstruction. Eur Spine J, 2010, 19(6): 1039-1040.
33. Humphries WE 3rd, Satyan KB, Relyea K, et al. Low-grade myofibroblastic sarcoma of the sacrum. J Neurosurg Pediatr, 2010, 6(3): 286-290.
34. Gallia GL, Suk I, Witham TF, et al. Lumbopelvic reconstruction after combined L5 spondylectomy and total sacrectomy for en bloc resection of a malignant fibrous histiocytoma. Neurosurgery, 2010, 67(2): E498-502.
35. 姬涛, 郭卫, 杨荣利, 等. 高位骶骨肿瘤切除内固定术后内置物断裂原因分析. 中国脊柱脊髓杂志, 2015, 25(1): 39-44.
36. Clark AJ, Tang JA, Leasure JM, et al. Gait-simulating fatigue loading analysis and sagittal alignment failure of spinal pelvic reconstruction after total sacrectomy: comparison of 3 techniques. J Neurosurg Spine, 2014, 20(4): 364-370.
37. Cheng L, Yu Y, Zhu R, et al. Structural stability of different reconstruction techniques following total sacrectomy: a biomechanical study. Clin Biomech (Bristol, Avon), 2011, 26(10): 977-981.
38. Zhu R, Cheng LM, Yu Y, et al. Comparison of four reconstruction methods after total sacrectomy: a finite element study. Clin Biomech (Bristol, Avon), 2012, 27(8): 771-776.
39. Yu Y, Zhu R, Zeng ZL, et al. The strain at bone-implant interface determines the effect of spinopelvic reconstruction following total sacrectomy: a strain gauge analysis in various spinopelvic constructs. PLoS One, 2014, 9(1): e85298.
40. Wuisman P, Lieshout O, van Dijk M, et al. Reconstruction after total en bloc sacrectomy for osteosarcoma using a custom-made prosthesis: a technical note. Spine (Phila Pa 1976), 2001, 26(4): 431-439.
41. Wuisman P, Lieshout O, Sugihara S, et al. Total sacrectomy and reconstruction: oncologic and functional outcome. Clin Orthop Relat Res, 2000, (381): 192-203.
42. Wei R, Guo W, Ji T, et al. One-step reconstruction with a 3D-printed, custom-made prosthesis after total en bloc sacrectomy: a technical note. Eur Spine J, 2017, 26(7): 1902-1909.
43. 肖建如, 贾连顺, 陈华江, 等. 高位骶骨肿瘤切除与重建方式探讨. 中华外科杂志, 2003, 41(8): 575-577.

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