Management of Sacral Tumors Requiring Spino-Pelvic Reconstruction with Different Histopathologic Diagnosis: Evaluation with Four Cases

Arıkan, Murat; Toğral, Güray; Hastürk, Aşkın Esen; Kekeç, Fevzi; Parpucu, Murat; Güngör, Şafak

doi:10.4184/asj.2015.9.6.971

Cited by 3 publications

(4 citation statements)

References 18 publications

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“…5,9,45 Instrumentation may be further augmented via sacroplasty using MMA or fibular allografts. 2,9 In our patient, posterior lumbopelvic fixation was achieved with double iliac screws bilaterally and a 4-rod technique. The sacrum was reconstructed directly onto the old corpectomy cage utilizing wires and MMA.…”

Section: Discussionmentioning

confidence: 90%

“…9,20,34 Sacrectomy involving S-1 requires instrumentation to allow weight-bearing ability postoperatively. 2 The options for lumbosacral reconstruction include spinopelvic fixation with pedicle and iliac screw-rod systems, posterior pelvic ring fixation (using transiliac bars, custom plates, structural allografts, prosthetic cages, or U-shaped rods), and anterior spinal column fixation (using iliolumbar screws, vertical rods, titanium mesh, expandable cages, or fibular grafts). 5,9,45 Instrumentation may be further augmented via sacroplasty using MMA or fibular allografts.…”

Section: Discussionmentioning

confidence: 99%

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Rare case of a recurrent juvenile ossifying fibroma of the lumbosacral spine

Ore¹,

Lau²,

Davis

et al. 2018

Journal of Neurosurgery: Spine

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Juvenile ossifying fibroma (JOF) is a rare benign bone tumor that occurs most frequently in the craniofacial bones of children and young adults. There are few case reports that describe its involvement outside the craniofacial skeleton, especially within the spinal column. While JOF is classified as a benign lesion, it may be locally aggressive and demonstrate a high propensity for recurrence, even after resection. Definitive surgical management may be challenging in naive cases, but it is particularly challenging in recurrent cases and when extensive spinal reconstruction is warranted. In this report, the authors describe the diagnosis and surgical management of a 29-year-old man who presented with a large recurrent sacral trabecular-subtype JOF. A review of literature regarding JOFs, management of recurrent primary spinal tumors, and sacral reconstruction are discussed.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Rare case of a recurrent juvenile ossifying fibroma of the lumbosacral spine

Ore¹,

Lau²,

Davis

et al. 2018

Journal of Neurosurgery: Spine

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“…This was to help prevent tumor recurrence into a small resection cavity rather than to provide biomechanical support. In another case report by Arikan et al, 20 PMMA was injected into the resection cavity of a sacral giant cell tumor with preservation of the S1 root. Although this case reported the addition of PMMA to instrumentation to increase pelvic stability, the patient still required extension of fusion into the lumbar spine.…”

Section: Discussionmentioning

confidence: 99%

Sacroplasty Augmentation of Instrumented Pelvic Reconstruction After High Sacrectomy: A Technical Case Report

Sacino¹,

Pairojboriboon²,

Suk³

et al. 2021

ONSURG

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BACKGROUND AND IMPORTANCE En bloc resection of sacral tumors is the most effective treatment to help prevent recurrence. Sacrectomy, however, can be destabilizing, depending on the extent of resection. Various surgical techniques for improving stability and enabling early ambulation have been proposed. CLINICAL PRESENTATION Here, we report a case in which we use PMMA (poly[methyl methacrylate]) to augment pelvic instrumentation to improve mechanical stability after sacrectomy for en bloc resection of a solitary fibrous tumor. CONCLUSION We highlight the use of sacroplasty augmentation of pelvic ring reconstruction to provide biomechanical stability without the need for fusion of any mobile spine segments, which allowed for early patient ambulation and no appreciable loss of range of motion or mobility.

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“…58,62,63,66 Because of these issues, it is unclear what bone graft options should be selected in patients with spinal column tumors. The literature is also significantly limited, as a majority of prior reports were either retrospective with small numbers of patients, 1,36 or case reports, 5 focusing on survival outcomes or technical aspects of surgery rather than fusion outcomes. 73 To the best of our knowledge, this is the first systematic review and meta-analysis focusing solely on bone graft options and fusion rates in the setting of spinal column tumor resection, aiming to provide some clinical insight into this controversial issue.…”

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confidence: 99%

Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

Elder

Ishida

Goodwin

et al. 2017

FOC

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OBJECTIVE With the advent of new adjunctive therapy, the overall survival of patients harboring spinal column tumors has improved. However, there is limited knowledge regarding the optimal bone graft options following resection of spinal column tumors, due to their relative rarity and because fusion outcomes in this cohort are affected by various factors, such as radiation therapy (RT) and chemotherapy. Furthermore, bone graft options are often limited following tumor resection because the use of local bone grafts and bone morphogenetic proteins (BMPs) are usually avoided in light of microscopic infiltration of tumors into local bone and potential carcinogenicity of BMP. The objective of this study was to review and meta-analyze the relevant clinical literature to provide further clinical insight regarding bone graft options. METHODS A web-based MEDLINE search was conducted in accordance with preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, which yielded 27 articles with 383 patients. Information on baseline characteristics, tumor histology, adjunctive treatments, reconstruction methods, bone graft options, fusion rates, and time to fusion were collected. Pooled fusion rates (PFRs) and I2 values were calculated in meta-analysis. Meta-regression analyses were also performed if each variable appeared to affect fusion outcomes. Furthermore, data on 272 individual patients were available, which were additionally reviewed and statistically analyzed. RESULTS Overall, fusion rates varied widely from 36.0% to 100.0% due to both inter- and intrastudy heterogeneity, with a PFR of 85.7% (I2 = 36.4). The studies in which cages were filled with morselized iliac crest autogenic bone graft (ICABG) and/or other bone graft options were used for anterior fusion showed a significantly higher PFR of 92.8, compared with the other studies (83.3%, p = 0.04). In per-patient analysis, anterior plus posterior fusion resulted in a higher fusion rate than anterior fusion only (98.8% vs 86.4%, p < 0.001). Although unmodifiable, RT (90.3% vs 98.6%, p = 0.03) and lumbosacral tumors (74.6% vs 97.9%, p < 0.001) were associated with lower fusion rates in univariate analysis. The mean time to fusion was 5.4 ± 1.4 months (range 3–9 months), whereas 16 of 272 patients died before the confirmation of solid fusion with a mean survival of 3.1 ± 2.1 months (range 0.5–6 months). The average time to fusion of patients who received RT and chemotherapy were significantly longer than those who did not receive these adjunctive treatments (RT: 6.1 months vs 4.3 months, p < 0.001; chemotherapy: 6.0 months vs 4.3 months, p = 0.02). CONCLUSIONS Due to inter- and intrastudy heterogeneity in patient, disease, fusion criteria, and treatment characteristics, the optimal surgical techniques and factors predictive of fusion remain unclear. Clearly, future prospective, randomized studies will be necessary to better understand the issues surrounding bone graft selection following resection of spinal column tumors.

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Management of Sacral Tumors Requiring Spino-Pelvic Reconstruction with Different Histopathologic Diagnosis: Evaluation with Four Cases

Cited by 3 publications

References 18 publications

Rare case of a recurrent juvenile ossifying fibroma of the lumbosacral spine

Rare case of a recurrent juvenile ossifying fibroma of the lumbosacral spine

Sacroplasty Augmentation of Instrumented Pelvic Reconstruction After High Sacrectomy: A Technical Case Report

Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

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