Tags

Type your tag names separated by a space and hit enter

Sacral tumor resection and the impact on pelvic incidence.
J Neurosurg Spine. 2011 Jan; 14(1):78-84.JN

Abstract

OBJECT

pelvic incidence (PI) directly regulates lumbar lordosis and is a key determinant of sagittal spinal balance in normal and diseased states. Pelvic incidence is defined as the angle between the line perpendicular to the S-1 endplate at its midpoint and the line connecting this point to a line bisecting the center of the femoral heads. It reflects an anatomical value that increases with growth during childhood but remains constant in adulthood. It is not altered by changes in patient position or after traditional lumbosacral spinal surgery. There are only 2 reports of PI being altered in adults, both in cases of sacral fractures resulting in lumbopelvic dissociation and sacroiliac (SI) joint instability. En bloc sacral amputation and sacrectomy are surgical techniques used for resection of certain bony malignancies of the sacrum. High, mid, and low sacral amputations result in preservation of some or the entire SI joint. Total sacrectomy results in complete disruption of the SI joint. The purpose of this study was to determine if PI is altered as a result of total or subtotal sacral resection.

METHODS

the authors reviewed a series of 42 consecutive patients treated at The Johns Hopkins Hospital between 2004 and 2009 for sacral tumors with en bloc resection. The authors evaluated immediate pre- and postoperative images for modified pelvic incidence (mPI) using the L-5 inferior endplate, as the patients undergoing a total sacrectomy are missing the S-1 endplate postoperatively. The authors compared the results of total versus subtotal sacrectomies.

RESULTS

twenty-two patients had appropriate images to measure pre- and postoperative mPI; 17 patients had high, mid, or low sacral amputations with sparing of some or the entire SI joint, and 5 patients underwent a total sacrectomy, with complete SI disarticulation. The mean change in mPI was statistically different (p < 0.001) for patients undergoing subtotal versus those undergoing total sacrectomy (1.6° ± 0.9° vs 13.6° ± 4.9° [± SD]). There was no difference between patients who underwent a high sacral amputation (partial SI resection, mean 1.6°) and mid or low sacral amputation (SI completely intact, mean 1.6°).

CONCLUSIONS

the PI is altered during total sacrectomy due to complete disarticulation of the SI joint and discontinuity of the spine and pelvis, but it is not changed if any of the joint is preserved. Changes in PI influence spinopelvic balance and may have postoperative clinical importance. Thus, the authors encourage attention to spinopelvic alignment during lumbopelvic reconstruction and fixation after tumor resection. Long-term studies are needed to evaluate the impact of the change in PI on sagittal balance, pain, and ambulation after total sacrectomy.

Authors+Show Affiliations

Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA. Ogottfr1@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21142465

Citation

Gottfried, Oren N., et al. "Sacral Tumor Resection and the Impact On Pelvic Incidence." Journal of Neurosurgery. Spine, vol. 14, no. 1, 2011, pp. 78-84.
Gottfried ON, Omeis I, Mehta VA, et al. Sacral tumor resection and the impact on pelvic incidence. J Neurosurg Spine. 2011;14(1):78-84.
Gottfried, O. N., Omeis, I., Mehta, V. A., Solakoglu, C., Gokaslan, Z. L., & Wolinsky, J. P. (2011). Sacral tumor resection and the impact on pelvic incidence. Journal of Neurosurgery. Spine, 14(1), 78-84. https://doi.org/10.3171/2010.9.SPINE09728
Gottfried ON, et al. Sacral Tumor Resection and the Impact On Pelvic Incidence. J Neurosurg Spine. 2011;14(1):78-84. PubMed PMID: 21142465.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sacral tumor resection and the impact on pelvic incidence. AU - Gottfried,Oren N, AU - Omeis,Ibrahim, AU - Mehta,Vivek A, AU - Solakoglu,Can, AU - Gokaslan,Ziya L, AU - Wolinsky,Jean-Paul, Y1 - 2010/12/03/ PY - 2010/12/15/entrez PY - 2010/12/15/pubmed PY - 2011/1/28/medline SP - 78 EP - 84 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 14 IS - 1 N2 - OBJECT: pelvic incidence (PI) directly regulates lumbar lordosis and is a key determinant of sagittal spinal balance in normal and diseased states. Pelvic incidence is defined as the angle between the line perpendicular to the S-1 endplate at its midpoint and the line connecting this point to a line bisecting the center of the femoral heads. It reflects an anatomical value that increases with growth during childhood but remains constant in adulthood. It is not altered by changes in patient position or after traditional lumbosacral spinal surgery. There are only 2 reports of PI being altered in adults, both in cases of sacral fractures resulting in lumbopelvic dissociation and sacroiliac (SI) joint instability. En bloc sacral amputation and sacrectomy are surgical techniques used for resection of certain bony malignancies of the sacrum. High, mid, and low sacral amputations result in preservation of some or the entire SI joint. Total sacrectomy results in complete disruption of the SI joint. The purpose of this study was to determine if PI is altered as a result of total or subtotal sacral resection. METHODS: the authors reviewed a series of 42 consecutive patients treated at The Johns Hopkins Hospital between 2004 and 2009 for sacral tumors with en bloc resection. The authors evaluated immediate pre- and postoperative images for modified pelvic incidence (mPI) using the L-5 inferior endplate, as the patients undergoing a total sacrectomy are missing the S-1 endplate postoperatively. The authors compared the results of total versus subtotal sacrectomies. RESULTS: twenty-two patients had appropriate images to measure pre- and postoperative mPI; 17 patients had high, mid, or low sacral amputations with sparing of some or the entire SI joint, and 5 patients underwent a total sacrectomy, with complete SI disarticulation. The mean change in mPI was statistically different (p < 0.001) for patients undergoing subtotal versus those undergoing total sacrectomy (1.6° ± 0.9° vs 13.6° ± 4.9° [± SD]). There was no difference between patients who underwent a high sacral amputation (partial SI resection, mean 1.6°) and mid or low sacral amputation (SI completely intact, mean 1.6°). CONCLUSIONS: the PI is altered during total sacrectomy due to complete disarticulation of the SI joint and discontinuity of the spine and pelvis, but it is not changed if any of the joint is preserved. Changes in PI influence spinopelvic balance and may have postoperative clinical importance. Thus, the authors encourage attention to spinopelvic alignment during lumbopelvic reconstruction and fixation after tumor resection. Long-term studies are needed to evaluate the impact of the change in PI on sagittal balance, pain, and ambulation after total sacrectomy. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/21142465/Sacral_tumor_resection_and_the_impact_on_pelvic_incidence_ L2 - https://thejns.org/doi/10.3171/2010.9.SPINE09728 DB - PRIME DP - Unbound Medicine ER -