Pelvic Strength After Major Amputation of the Sacrum:<i>An Experimental Study</i>

Gunterberg, Björn; Romanus, B.; Stener, Bertil

doi:10.3109/17453677608988751

Cited by 159 publications

(74 citation statements)

References 7 publications

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“…Patients who were certain to lose bowel control because of S2 nerve roots involvement also had a combined approach with colostomy formation. Lumbosacral stabilization was performed when greater than 50% of either sacroiliac joint was resected, as this destabilizes the pelvis [16]. The anterior procedure is performed by a general surgeon through a midline laparotomy incision.…”

Section: Methodsmentioning

confidence: 99%

“…Bone wax is used for the bony elements. Spinopelvic reconstruction with rods and pedicle screws is performed when required [16]. The omentum then is pulled through and laid across the defect posteriorly.…”

Section: Methodsmentioning

confidence: 99%

“…Sacral chordomas grow slowly and metastasize late in 20% to 40% of patients, to the lungs, liver, bone, and soft tissues. Ten-year survival ranges from 30% to 65% [3,4,15,16,18,24,31]. Complete surgical excision is a prerequisite to prolonged survival.…”

Section: Introductionmentioning

confidence: 99%

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Sacral Chordoma: Can Local Recurrence After Sacrectomy Be Predicted?

Hanna¹,

Aston²,

Briggs³

et al. 2008

Clin Orthop Relat Res

108

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Surgical resection margins are reportedly the most important predictor of survival and local recurrence with sacral chordomas. We examined the relevance of invasion of the surrounding posterior pelvic musculature (piriformis and gluteus maximus) at initial diagnosis to local recurrence after sacrectomy. We retrospectively reviewed 18 patients with histologically verified sacral chordoma seen at our institution between 1998 and 2005. There were 14 men and four women with a mean age of 65.1 years (range, 31-78 years). The average overall followup was 4.4 years (range, 0.5-10 years), 5.4 years for the living patients (range, 3-10 years), and 2.8 years for the deceased (range, 0.5-5.4 years). Local recurrence occurred in 12 patients (66%) 29 months postoperatively (range, 2-84 months

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Sacral Chordoma: Can Local Recurrence After Sacrectomy Be Predicted?

Hanna¹,

Aston²,

Briggs³

et al. 2008

Clin Orthop Relat Res

108

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“…Several studies have demonstrated that a negative surgical margin is the most important predictor of the local recurrence rate and survival [3,12,13,44]; however, wide resection is not achieved in 35% to 75% of patients undergoing surgery for this diagnosis [42]. Surgery in this anatomic site is challenging as a result of the complexity of the pelvic anatomy, adjacent visceral and vascular structures, and frequent compromise of spinopelvic continuity [12,17,32]. Surgeons often face a difficult choice between maximizing the preservation of function and achieving an adequate surgical margin.…”

Section: Introductionmentioning

confidence: 99%

What Are the Conditional Survival and Functional Outcomes After Surgical Treatment of 115 Patients With Sacral Chordoma?

Guo

Yang

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Conditional survival is a measure of prognosis for patients who have already survived for a specific period of time; however, data on conditional survival after sacrectomy in patients with sacral chordoma are lacking. In addition, because sacral tumors are rare and heterogeneous, classifying them in a way that allows physicians to predict functional outcomes after sacrectomy remains a challenge. Questions/purposes (1) What is the overall survival and disease-free survival in patients treated by sacrectomy for chordoma? (2) What is the conditional survival probability and how do prognostic factors change over time in patients undergoing surgical resection for sacral chordoma? (3) What is the local recurrence rate after surgery, how was it treated, and what factors impact on local recurrence? (4) What is the postoperative motor, sensory, bowel, and bladder function by level of resection as determined by using a newly designed scoring method?Methods Between 2003 and 2012, our center treated 122 patients surgically for sacral chordoma. Of those, two died and five were lost before a minimum followup of 1 year was achieved, leaving 115 patients available for analysis in this retrospective study at a mean of 4.9 years (range, 1.3-10.8 years). Basically, single posterior or combined approaches were chosen based on the most cephalad extent of the tumor and resection level was normally at half or one sacral vertebrae above the tumor. The 5-year conditional survival rate was calculated based on Kaplan-Meier survival analysis. The effect of prognostic factors on conditional survival was also explored. A newly designed score method was proposed and adopted in the current study to critically evaluate the functional outcome after resection of the sacrum. Inter-and intraobserver reliability was tested by a preliminary study using kappa statistics and Spearman rank correlation coefficients. Significant interobserver (p\0.01) and intraobserver agreement (j[0.75) were found in nine items between each observer. Results The estimated 5-year overall survival rate was 81% (95% confidence interval [CI], 72%-90%) at diagnosis. The 5-year disease-free survival rate was 52% (95% CI, 43%-63%). The 5-year conditional overall survival decreased with each additional year in the first 4 years (81% at diagnosis versus 60% at the fourth year, p \ 0.0001) and increased slightly in the fifth year. Patients with adequate surgical margins displayed a higher 5-year survival than those with an inadequate margin (86% [95% CI, 76%-95%] versus 67% [95% CI, 48%-85%], p = 0.01) at diagnosis. Conditional survival estimates for patients who received operations elsewhere were lower than that of newly diagnosed patients treated by us at diagnosis (64% [95% CI, 46%-83%] versus 90% [95% CI, 82%-99%], p = 0.012), but with the numbers we had, we could not detect a difference in conditional survival between those treated elsewhere first compared with those initially treated by us at 5 years. The proposed score system for function evaluation was a...

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“…29 Gunterberg and colleagues 25,27 studied the biomechanical effects of transverse partial sacrectomy using a cadaveric model with an axial load applied to the lumbosacral junction. In those studies, transverse amputations of the proximal sacrum, especially those that involve the sacral ala, significantly weakened the ability of the spinopelvic segment to resist vertical loading.…”

Section: 53mentioning

confidence: 99%

A new type of reconstruction of the hemipelvis after Type 3 amputative sacrectomy using pedicled fibula

Starantzis

Sakellariou

Rose

et al. 2014

SPI

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This is a technical note of pelvic reconstruction performed by an advanced multidisciplinary team. The authors report a new 3-stage reconstruction of the hemipelvis after Type 3 sacrectomy involving instrumented spinoiliac arthrodesis and pedicled fibula grafting in 2 patients. The anterior stage of the procedure begins with a transabdominal approach to mobilize the viscera and to free up the tumor from the vessels. The posterior divisions of internal iliac vessels, the middle sacral vessels, and the lateral sacral vessels are then ligated. An anterior vertebrectomy is done at the appropriate level, followed by an anterior osteotomy through the lateral planed surgical margin of the sacrum close to the salvaged sacroiliac joint. The second stage includes a major sacral resection with lower-extremity amputation from the pubic symphysis through the intact side of the sacrum, ipsilateral pedicled fibula harvesting, and closure with an ipsilateral pedicled quadriceps flap. The final stage involves reconstruction with lumboiliac instrumentation. The pedicled fibular graft left from the second stage is then placed distally within the previously created iliopectineal docking site and proximally within the L-5 docking site. The authors believe that this is a feasible and reproducible technique with theoretical advantages that have to be proved in the long-term follow-up.

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Pelvic Strength After Major Amputation of the Sacrum:An Experimental Study

Cited by 159 publications

References 7 publications

Sacral Chordoma: Can Local Recurrence After Sacrectomy Be Predicted?

Sacral Chordoma: Can Local Recurrence After Sacrectomy Be Predicted?

What Are the Conditional Survival and Functional Outcomes After Surgical Treatment of 115 Patients With Sacral Chordoma?

A new type of reconstruction of the hemipelvis after Type 3 amputative sacrectomy using pedicled fibula

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