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Reconstruction after total en bloc sacrectomy for osteosarcoma using a custom-made prosthesis: a technical note.
Spine (Phila Pa 1976). 2001 Feb 15; 26(4):431-9.S

Abstract

STUDY DESIGN

A report of an innovative technique to restore the lumbosacral junction after resection of primary highly malignant osteosarcoma of the sacrum involving the whole sacrum, soft tissues, and adjacent posterior parts of both iliac wings.

OBJECTIVES

To describe the planning and design of a custom-made sacral prosthesis, the surgical technique, and clinical and functional outcome of the patient.

SUMMARY OF BACKGROUND DATA

Although there have been case reports about reconstruction methods after total sacrectomy, to date, there has not been a reported clinical case of successful reconstruction using an individual designed prosthesis based on a three-dimensional real-sized model.

METHODS

A 42-year-old woman was referred with progressive neurologic impairment due to primary osteosarcoma of the sacrum invading surrounding structures. Based on a three-dimensional real-sized model, a detailed surgical plan was developed to assure safe, wide surgical margins. In addition, the model enabled design and testing of a custom-made sacral prosthesis, to provide stable lumbosacral reconstruction.

RESULTS

After induction chemotherapy, a staged anteroposterior resection-reconstruction was successfully performed. After surgery, a superficial wound dehiscence was promptly treated. Within 3 weeks after surgery, mobilization began, and the adjuvant chemotherapy was continued. At the 36-month follow-up, the patient was disease free, had a stable, painless spinopelvic junction, and could walk short distances using ankle orthoses and crutches. Radiographs show complete incorporation of the pelvic grafts and unchanged position of the implant.

CONCLUSIONS

In planning and performing a total sacrectomy, including substantial parts of iliac wings, a three-dimensional real-sized model offers surgeons distinct advantages. Wide bony resection margins can be drawn on the model, and an individual custom-made prosthesis to re-establish spinopelvic continuity can be designed and tested before the intervention.

Authors+Show Affiliations

Departments of Orthopaedic Surgery and Pathology, Free University Hospital, Amsterdam, The Netherlands. orthop@azvu.nlNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

11224892

Citation

Wuisman, P, et al. "Reconstruction After Total En Bloc Sacrectomy for Osteosarcoma Using a Custom-made Prosthesis: a Technical Note." Spine, vol. 26, no. 4, 2001, pp. 431-9.
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. 2001;26(4):431-9.
Wuisman, P., Lieshout, O., van Dijk, M., & van Diest, P. (2001). Reconstruction after total en bloc sacrectomy for osteosarcoma using a custom-made prosthesis: a technical note. Spine, 26(4), 431-9.
Wuisman P, et al. Reconstruction After Total En Bloc Sacrectomy for Osteosarcoma Using a Custom-made Prosthesis: a Technical Note. Spine. 2001 Feb 15;26(4):431-9. PubMed PMID: 11224892.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reconstruction after total en bloc sacrectomy for osteosarcoma using a custom-made prosthesis: a technical note. AU - Wuisman,P, AU - Lieshout,O, AU - van Dijk,M, AU - van Diest,P, PY - 2001/2/27/pubmed PY - 2001/5/25/medline PY - 2001/2/27/entrez SP - 431 EP - 9 JF - Spine JO - Spine VL - 26 IS - 4 N2 - STUDY DESIGN: A report of an innovative technique to restore the lumbosacral junction after resection of primary highly malignant osteosarcoma of the sacrum involving the whole sacrum, soft tissues, and adjacent posterior parts of both iliac wings. OBJECTIVES: To describe the planning and design of a custom-made sacral prosthesis, the surgical technique, and clinical and functional outcome of the patient. SUMMARY OF BACKGROUND DATA: Although there have been case reports about reconstruction methods after total sacrectomy, to date, there has not been a reported clinical case of successful reconstruction using an individual designed prosthesis based on a three-dimensional real-sized model. METHODS: A 42-year-old woman was referred with progressive neurologic impairment due to primary osteosarcoma of the sacrum invading surrounding structures. Based on a three-dimensional real-sized model, a detailed surgical plan was developed to assure safe, wide surgical margins. In addition, the model enabled design and testing of a custom-made sacral prosthesis, to provide stable lumbosacral reconstruction. RESULTS: After induction chemotherapy, a staged anteroposterior resection-reconstruction was successfully performed. After surgery, a superficial wound dehiscence was promptly treated. Within 3 weeks after surgery, mobilization began, and the adjuvant chemotherapy was continued. At the 36-month follow-up, the patient was disease free, had a stable, painless spinopelvic junction, and could walk short distances using ankle orthoses and crutches. Radiographs show complete incorporation of the pelvic grafts and unchanged position of the implant. CONCLUSIONS: In planning and performing a total sacrectomy, including substantial parts of iliac wings, a three-dimensional real-sized model offers surgeons distinct advantages. Wide bony resection margins can be drawn on the model, and an individual custom-made prosthesis to re-establish spinopelvic continuity can be designed and tested before the intervention. SN - 0362-2436 UR - https://www.unboundmedicine.com/medline/citation/11224892/Reconstruction_after_total_en_bloc_sacrectomy_for_osteosarcoma_using_a_custom_made_prosthesis:_a_technical_note_ L2 - http://dx.doi.org/10.1097/00007632-200102150-00021 DB - PRIME DP - Unbound Medicine ER -