Surgical Technique: Iliosacral Reconstruction With Minimal Spinal Instrumentation

Nassif, Nader; Buchowski, Jacob M.; Osterman, Kelly; McDonald, Douglas J.

doi:10.1007/s11999-012-2643-6

Cited by 19 publications

(45 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Eight pelves were reconstructed with spinal instrumentation. As previously described[14], a single 7.5mm diameter multiaxial pedicle screw (K2M Inc., Leesburg, VA, USA) was placed into the cut surface of the left sacral ala into the sacral body and another was placed into the cut surface of the ilium and passing through the posterior column of the acetabulum into the ischium. These were then connected with a 5.5mm titanium rod, which was bent and cut to fit the screw orientation and defect size (Figure 1C).…”

Section: Methodsmentioning

confidence: 99%

“…Composite bone grafts were cut to length to span the defect and were wedged into the cut ends of the sacrum and ilium bones in each reconstructed model, similar to the clinical scenario. No screws were placed into the graft in either reconstruction method to replicate our surgical technique as closely as possible[14]. Given the lack of fixation as well as the necessary horizontal orientation of the grafts, the grafts are not thought to contribute to construct strength at time-zero, and all deforming forces are resisted solely by the implants.…”

Section: Methodsmentioning

confidence: 99%

“…While the type of interposition graft used has been a focus of a number of case series[2, 5, 14, 15, 18–20], the type of fixation used for this type of reconstruction is a vital consideration that has not been rigorously studied. The most common method of fixation in the literature is some form of plate and screw fixation[15, 19], though screws alone have been used in many cases[2, 3, 5].…”

Section: Introductionmentioning

confidence: 99%

“…While some constructs involve extensive dissection as high as the third lumbar spine pedicle[19], we have advocated for a minimal spinal instrumentation technique to minimize dissection and theoretically preserve more local blood supply. This technique was demonstrated in a prior case study with comparable clinical results to standard spinal fixation[14]. A successful reconstruction must satisfy two requirements: initial fixation must be rigid enough to reduce motion at the graft-pelvis interfaces to allow for bony union, and fixation must be strong enough to resist catastrophic failure in the time prior to graft healing where it is responsible for the majority of posterior pelvic stability.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Mechanical comparison of iliosacral reconstruction techniques after sarcoma resection

Louer

Nassif

Brodt

et al. 2016

Clinical Biomechanics

Self Cite

View full text Add to dashboard Cite

Background: Reconstruction of iliosacral defects following oncologic resection is a difficult clinical problem associated with a high incidence of failure. Technical approaches to this problem are heterogeneous and evidence supporting specific techniques is sparse. Maximizing construct stability may improve union rates and functional outcomes. The purpose of this study is to compare construct stiffness, load to failure, and mechanism of failure between two methods of iliosacral reconstruction in an ex-vivo model to determine if either is mechanically superior. Methods: Eight third-generation composite pelves reconstructed with a plate-and-screw technique were tested against seven pelves reconstructed with a minimal spinal instrumentation technique using axial loading in a double-leg stance model. Findings: The pelves from the plate group demonstrated higher stiffness in the direction of applied load (102.9 vs. 66.8 N/mm; p=0.010) and endured a significantly larger maximum force (1416 vs. 1059 N; p=0.015) than the rod group prior to failure. Subjectively, the rod-reconstructed pelves were noted to be rotationally unconstrained while pivoting around their single point-of fixation in each segment leading to earlier failure. Interpretation: Plate-reconstruction was mechanically superior to spinal instrumentation in the manner performed in this study. More than one point of fixation in each segment should be achieved to minimize the risk of rotational deformation.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Mechanical comparison of iliosacral reconstruction techniques after sarcoma resection

Louer

Nassif

Brodt

et al. 2016

Clinical Biomechanics

Self Cite

View full text Add to dashboard Cite

show abstract

“…Here, we do not discuss the special consequences of the extended internal hemipelvectomies, only mention the Type I/S hemipelvectomy when resection of the ilium is performed with the resection of a portion of the sacrum 10 . In these cases, the reconstruction of the sacropelvic region can be performed with unilateral constructs depending on the extent of the sacral and pelvic resection [11][12][13] .…”

Section: The Role Of the Sacroiliac Jointmentioning

confidence: 99%

Surgical resection and reconstruction after resection of tumors involving the sacropelvic region

Varga

Szövérfi

Lazáry

2014

Neurological Research

View full text Add to dashboard Cite

ObjectivesSurgical management of the tumors in the sacropelvic region is a challenging field of spine surgery because of the complex local anatomy and biomechanics. Recent development in anesthesia and intensive care has allowed us to perform extended surgeries focused on the en bloc resection of sacropelvic tumors. Various techniques for the resection and for the reconstruction were published in the last decade. MethodsSacropelvic tumor resection techniques and methods for the biomechanical and soft-tissue reconstruction are reviewed in this paper. ResultsLiterature data is based on case reports and case-series. Several different techniques were developed for the lumbopelvic stabilization after sacropelvic tumor resection according to three different reconstruction principles (spinopelvic fixation, posterior pelvic ring fixation, anterior spinal column fixation); however, long term follow up data and comparative studies of the different techniques are still missing. Soft-tissue reconstruction can be performed according to an algorithm depending on the surgical approach, but relatively high complication rates are reported with all reconstruction strategies. The clinical outcome of such surgeries should ideally be evaluated in three dimensions; surgical-, oncological-, and functional outcomes. The last, and most important step of the presurgical planning procedure is a careful presentation of the surgical goals and risks to the patient, who must provide a fully informed consent before surgery can proceed. Discussion Sacropelvic tumors are rare conditions. In the last decade, growing evidence was published on resection and reconstruction techniques for these tumors; however, experience at most medical centers is limited by the low case-number. Formation of international expert groups and initiation of multicenter studies is strongly encouraged to produce a high level of evidence in this special field of spine surgery.

show abstract

Pelvic ring reconstruction with double‐barreled fibular free flap: A systematic review

et al. 2021

View full text Add to dashboard Cite

Introduction: Pelvic ring reconstruction after internal hemipelvectomy is an extremely challenging surgical procedure, and mandatory reconstruction is to provide a durable and pain-free functional outcome, especially for young, active patients.One of the most widely employed techniques is reconstruction with a doublebarreled fibular free flap (DBF). The aim of our work was an in-depth analysis of the outcome of pelvic ring reconstruction performed using the above-mentioned method, in particular looking for a correlation between the fixation technique and either ambulation status or complications. Materials and methods:A systematic review was performed in November 2020 using PubMed and MedLine Ovid databases according to the PRISMA guidelines and the results were statistically analyzed.Results: Studies were published between 1994 and 2015. A DBF was used in each case, with a total of 30 patients. Reconstruction was performed with screws in 13 cases, Cotrel-Dubousset rod fixation in 6, screws and plate in 5, screws with external fixation in 4, and ISOLA in 2. Follow-up time ranged from 3 to 131 months.Functional outcome was excellent in 4 patients and good in 26 patients. Statistical analysis showed no statistical evidence of existing correlation between fixation technique and complications (p = .873), while statistical correlation between age and fixation technique was found (p < .001). Conclusion:Reconstruction of pelvic ring with DBF provides an overall good functional outcome. Our data indicate that there is no statistical evidence of existing correlation between the fixation technique and either complications or ambulation status.

show abstract

Surgical Technique: Iliosacral Reconstruction With Minimal Spinal Instrumentation

Abstract: Background Posterior pelvic ring reconstruction can be challenging and controversial. The choice regarding whether to reconstruct and how to reconstitute the pelvic ring is unclear. Many methods provide stability but often are technically difficult and require excessive dissection.

Cited by 19 publications

References 16 publications

Mechanical comparison of iliosacral reconstruction techniques after sarcoma resection

Mechanical comparison of iliosacral reconstruction techniques after sarcoma resection

Surgical resection and reconstruction after resection of tumors involving the sacropelvic region

Pelvic ring reconstruction with double‐barreled fibular free flap: A systematic review

Contact Info

Product

Resources

About