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Surgical techniques for total sacrectomy and spinopelvic reconstruction.
Neurosurg Focus. 2003 Aug 15; 15(2):E5.NF

Abstract

The surgical management of sacral tumors requires partial or total sacrectomy and spinopelvic reconstruction. These lesions present a great surgical challenge, because most spine surgeons are unfamiliar with the techniques required for these procedures. The authors describe a step-by-step operative technique and provide several illustrations. Total sacrectomy is performed by sequential anterior and posterior approaches that involve a rectus abdominis pullthrough pedicle flap reconstruction. The anterior procedure is an intraperitoneal approach used to expose the anterior aspect of the tumor, to ligate the main tumor vessels, and to conduct an anterior partial sacrectomy. After this, the rectus abdominis myocutaneous flap, based on the inferior epigastric vessel, is prepared, and a posterior sacrectomy is performed, dividing all sacral nerve roots in the thecal sac. After complete en bloc extirpation of the sacrum with tumor, spinopelvic reconstruction and closure with a myocutaneous flap are performed. Spinopelvic reconstruction is undertaken using a modified Galveston technique or double iliac screw fixation combined with posterior lumbar segmental fixation. These provide a long lever arm within the ilium to counteract the forces exerted by the lumbar spine. Understanding the nature of the disease as well as the biomechanics of the lumbosacral pelvic area and spinopelvic fixation will help surgeons select the appropriate treatment for sacral tumors.

Authors+Show Affiliations

Department of Neurosurgery, Stanford University Medical Center, Stanford, California 94305-5327, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

15350036

Citation

Zhang, Ho-Yeol, et al. "Surgical Techniques for Total Sacrectomy and Spinopelvic Reconstruction." Neurosurgical Focus, vol. 15, no. 2, 2003, pp. E5.
Zhang HY, Thongtrangan I, Balabhadra RS, et al. Surgical techniques for total sacrectomy and spinopelvic reconstruction. Neurosurg Focus. 2003;15(2):E5.
Zhang, H. Y., Thongtrangan, I., Balabhadra, R. S., Murovic, J. A., & Kim, D. H. (2003). Surgical techniques for total sacrectomy and spinopelvic reconstruction. Neurosurgical Focus, 15(2), E5.
Zhang HY, et al. Surgical Techniques for Total Sacrectomy and Spinopelvic Reconstruction. Neurosurg Focus. 2003 Aug 15;15(2):E5. PubMed PMID: 15350036.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical techniques for total sacrectomy and spinopelvic reconstruction. AU - Zhang,Ho-Yeol, AU - Thongtrangan,Issada, AU - Balabhadra,Raju S V, AU - Murovic,Judith A, AU - Kim,Daniel H, Y1 - 2003/08/15/ PY - 2004/9/8/pubmed PY - 2005/5/6/medline PY - 2004/9/8/entrez SP - E5 EP - E5 JF - Neurosurgical focus JO - Neurosurg Focus VL - 15 IS - 2 N2 - The surgical management of sacral tumors requires partial or total sacrectomy and spinopelvic reconstruction. These lesions present a great surgical challenge, because most spine surgeons are unfamiliar with the techniques required for these procedures. The authors describe a step-by-step operative technique and provide several illustrations. Total sacrectomy is performed by sequential anterior and posterior approaches that involve a rectus abdominis pullthrough pedicle flap reconstruction. The anterior procedure is an intraperitoneal approach used to expose the anterior aspect of the tumor, to ligate the main tumor vessels, and to conduct an anterior partial sacrectomy. After this, the rectus abdominis myocutaneous flap, based on the inferior epigastric vessel, is prepared, and a posterior sacrectomy is performed, dividing all sacral nerve roots in the thecal sac. After complete en bloc extirpation of the sacrum with tumor, spinopelvic reconstruction and closure with a myocutaneous flap are performed. Spinopelvic reconstruction is undertaken using a modified Galveston technique or double iliac screw fixation combined with posterior lumbar segmental fixation. These provide a long lever arm within the ilium to counteract the forces exerted by the lumbar spine. Understanding the nature of the disease as well as the biomechanics of the lumbosacral pelvic area and spinopelvic fixation will help surgeons select the appropriate treatment for sacral tumors. SN - 1092-0684 UR - https://www.unboundmedicine.com/medline/citation/15350036/Surgical_techniques_for_total_sacrectomy_and_spinopelvic_reconstruction_ L2 - https://thejns.org/doi/10.3171/foc.2003.15.2.5 DB - PRIME DP - Unbound Medicine ER -