One‐Step Reconstruction with a Novel Suspended, Modular, and 3D‐Printed Total Sacral Implant Resection of Sacral Giant Cell Tumor with Preservation of Bilateral S_1–3 Nerve Roots via a Posterior‐Only Approach

Abstract

Objective To investigate the efficacy and safety of spinopelvic reconstruction based on a novel suspended, modular, and 3D‐printed total sacral implant after total piecemeal resection of a sacral giant cell tumor (SGCT) with the preservation of bilateral S1–3 nerve roots via a posterior‐only approach. Methods Five patients who had undergone total piecemeal resection of SGCT involving upper sacral segments (S1 and S2) and the midline with the preservation of bilateral S1–3 nerve roots via a posterior‐only approach between September 2017 and July 2018 were retrospectively reviewed. A novel suspended, modular, and 3D‐printed total sacral implant had been used for reconstruction. This series included two female and three male patients, with a mean age of 42.2 years (range, 31–53 years). Surgical time, blood loss, complications, preoperative and postoperative neurological function, instrumentation failure, and local control were presented and analyzed. Results All patients underwent the operation without death or serious complications. The implant was installed on the defect, connecting the ilium and lumbar vertebrae, and fixed with a screw–rod system up to the level of L3–4 or L4–5. The mean operative time was 502 min (range, 360–640 min) and the mean operative blood loss 4400 mL (range, 3000–7000 mL). The mean follow‐up was 15 months. After the operation, pain was significantly relieved, and the patients resumed walking as early as 2 weeks later. The patients showed no neurogenic bladder dysfunction and no fecal incontinence or gait disturbance. Wound healing was poor in one patient. Patients recovered well without evidence of local recurrence. No implant failures or related clinical symptoms were detected during follow up. Satisfactory bone ingrowth and osseointegration at the bone‐implant junctions was found in follow‐up CT. Conclusion Although technically challenging, it is feasible and safe to use a suspended, modular, and 3D‐printed implant for reconstruction after total piecemeal resection with the preservation of bilateral S1–3 nerve roots in patients with SGCT. We believe that this implant can be applied to sacral reconstruction in a wide variety of diseases.

3D-printed personalised prostheses for bone defect repair and reconstruction following resection of metacarpal giant cell tumours

“…In recent years, en bloc resection followed by the use of a prosthesis for post-resection bone defect repair and reconstruction has become the preferred approach for GCT treatment among an increasing number of orthopedists. However, the poor fit of conventional prostheses leads to a high rate of complications such as implant loosening or failure, resulting in poor postoperative limb function among patients (5,6). Furthermore, the low incidence of metacarpal GCTs suggests that conventionally configured prostheses are currently unavailable for this condition.…”

Total sacrectomy with a combined antero-posterior surgical approach for malignant sacral tumours

“…Therefore, we believe that in ilio-lumbar reconstruction, the distance between the lumbar screw and the iliac screw should be shortened as much as possible. Generally, the lumbar screw should be fixed on the fourth and fifth vertebral bodies [ 6 ]. However, no systematic study has been conducted to determine whether increasing the number of screws reduces fixation failure.…”

“…However, no systematic study has been conducted to determine whether increasing the number of screws reduces fixation failure. Biological reconstruction is essential for long-term lumbosacral stability, and structural bone grafting can be performed using different bone-grafting materials, including autogenous fibula and allografts [ 6 , 33 ]. We used a large allograft segment combined with an internal fixation system to pressurise the bone to improve graft healing.…”

“…Total sacrectomy is a radical but effective treatment, and only extensive resection of the tumour can control local recurrence and prolong survival time [ 5 ]. Selection of the appropriate surgical approach is vital to resect sacral tumours completely, and most scholars adopt the combined antero-posterior approach [ 6 ]. This approach safely separates the rectum and blood vessels in the anterior sacral region, and the posterior incision is closed with a rectus flap [ 7 , 8 ].…”

Sacrum morphometry and spinopelvic parameters among the Indonesian population using computed tomography scans

“…In clinical settings, spinopelvic reconstruction post-sacrectomy, both total and partial, is widely used in the treatment of malignancies, traumas, infections (sacral tuberculosis), and degenerative diseases. [2][3][4] Spinopelvic reconstruction using prosthesis and implants may overcome spinopelvic instability to alleviate pain, promote early ambulation, and fill in the dead cavity (caused inevitably by the wide resection), and thus preventing sacrococcygeal herniation and the risk of infections and wound dehiscence. [5,6] However, the anatomical complexity of the bone remains a challenge in developing accurate prosthesis and installation technique, thus, requires detailed knowledge of the sacrum anatomy.…”