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Creation of false pedicles and a neo-pelvis for lumbopelvic reconstruction following en bloc resection of an iliosacral chondrosarcoma with lumbar spine extension: technical note.
J Neurosurg Spine. 2014 Mar; 20(3):327-34.JN

Abstract

En bloc resection with negative tumor margins remains the principal treatment option for control or cure of primary pelvic chondrosarcomas, as current adjuvant therapies remain ineffective. Iliosacral chondrosarcomas with involvement of the sciatic notch are sufficiently challenging tumors. However, when there is concomitant lumbar extension requiring resection of the pedicles to maintain negative surgical margins, transpedicular screw fixation is not possible, making reconstruction of the lumbopelvic junction extremely challenging. A patient with an iliosacral chondrosarcoma with lumbar spine extension is presented in this report to illustrate a novel lumbopelvic spinal construct. Following combined external pelvectomy and hemisacrectomy with contralateral L3-5 hemilaminectomy and ipsilateral pediculotomy, bicortical transvertebral body screws were substituted for the missing pedicles, resulting in the creation of "false pedicles," which were further supplemented with an autologous vascularized fibular strut graft from the amputated lower limb and applied to the lateral aspect of the vertebral bodies. The creation of false pedicles allowed for a robust reconstruction of the lumbopelvic junction, including maintaining pelvic ring integrity with a "neo-pelvis", creating a functional load-bearing construct adequate for early mobilization and ambulation. The biomechanical dynamics of this unique construct are also discussed.

Authors+Show Affiliations

Departments of Neurological Surgery.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

24405467

Citation

Mendel, Ehud, et al. "Creation of False Pedicles and a Neo-pelvis for Lumbopelvic Reconstruction Following En Bloc Resection of an Iliosacral Chondrosarcoma With Lumbar Spine Extension: Technical Note." Journal of Neurosurgery. Spine, vol. 20, no. 3, 2014, pp. 327-34.
Mendel E, Nathoo N, Scharschmidt T, et al. Creation of false pedicles and a neo-pelvis for lumbopelvic reconstruction following en bloc resection of an iliosacral chondrosarcoma with lumbar spine extension: technical note. J Neurosurg Spine. 2014;20(3):327-34.
Mendel, E., Nathoo, N., Scharschmidt, T., Schmidt, C., Boehmler, J., & Mayerson, J. L. (2014). Creation of false pedicles and a neo-pelvis for lumbopelvic reconstruction following en bloc resection of an iliosacral chondrosarcoma with lumbar spine extension: technical note. Journal of Neurosurgery. Spine, 20(3), 327-34. https://doi.org/10.3171/2013.11.SPINE13211
Mendel E, et al. Creation of False Pedicles and a Neo-pelvis for Lumbopelvic Reconstruction Following En Bloc Resection of an Iliosacral Chondrosarcoma With Lumbar Spine Extension: Technical Note. J Neurosurg Spine. 2014;20(3):327-34. PubMed PMID: 24405467.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Creation of false pedicles and a neo-pelvis for lumbopelvic reconstruction following en bloc resection of an iliosacral chondrosarcoma with lumbar spine extension: technical note. AU - Mendel,Ehud, AU - Nathoo,Narendra, AU - Scharschmidt,Thomas, AU - Schmidt,Carl, AU - Boehmler,James, AU - Mayerson,Joel L, Y1 - 2014/01/03/ PY - 2014/1/11/entrez PY - 2014/1/11/pubmed PY - 2014/5/13/medline SP - 327 EP - 34 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 20 IS - 3 N2 - En bloc resection with negative tumor margins remains the principal treatment option for control or cure of primary pelvic chondrosarcomas, as current adjuvant therapies remain ineffective. Iliosacral chondrosarcomas with involvement of the sciatic notch are sufficiently challenging tumors. However, when there is concomitant lumbar extension requiring resection of the pedicles to maintain negative surgical margins, transpedicular screw fixation is not possible, making reconstruction of the lumbopelvic junction extremely challenging. A patient with an iliosacral chondrosarcoma with lumbar spine extension is presented in this report to illustrate a novel lumbopelvic spinal construct. Following combined external pelvectomy and hemisacrectomy with contralateral L3-5 hemilaminectomy and ipsilateral pediculotomy, bicortical transvertebral body screws were substituted for the missing pedicles, resulting in the creation of "false pedicles," which were further supplemented with an autologous vascularized fibular strut graft from the amputated lower limb and applied to the lateral aspect of the vertebral bodies. The creation of false pedicles allowed for a robust reconstruction of the lumbopelvic junction, including maintaining pelvic ring integrity with a "neo-pelvis", creating a functional load-bearing construct adequate for early mobilization and ambulation. The biomechanical dynamics of this unique construct are also discussed. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/24405467/Creation_of_false_pedicles_and_a_neo_pelvis_for_lumbopelvic_reconstruction_following_en_bloc_resection_of_an_iliosacral_chondrosarcoma_with_lumbar_spine_extension:_technical_note_ L2 - https://thejns.org/doi/10.3171/2013.11.SPINE13211 DB - PRIME DP - Unbound Medicine ER -