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Total sacrectomy and Galveston L-rod reconstruction for malignant neoplasms. Technical note.
J Neurosurg. 1997 Nov; 87(5):781-7.JN

Abstract

Although radical resection is the best treatment for malignant sacral tumors, total sacrectomy for such tumors has been performed in only a few instances. Total sacral resection requires reconstruction of the pelvic ring plus establishment of a bilateral union between the lumbar spine and iliac bone. This technique is illustrated in two patients harboring large, painful, sacral giant-cell tumors that were unresponsive to prior treatment. These patients were treated with complete en bloc resection of the sacrum and complex iliolumbar reconstruction/stabilization and fusion. Surgery was performed in two stages, the first consisting of a midline celiotomy, dissection of visceral/neural structures, and ligation of internal iliac vessels, followed by an anterior L5-S1 discectomy. The second stage consisted of mobilization of an inferiorly based myocutaneous rectus abdominis pedicle flap for wound closure, followed by an L-5 laminectomy, bilateral L-5 foraminotomy, ligation of the thecal sac, division of sacral nerve roots, and transection of the ilia lateral to the tumor and sacroiliac joints. Placement of the instrumentation required segmental fixation of the lumbar spine from L-3 down by means of pedicle screws and the establishment of a bilateral liaison between the lumbar spine and the ilia by using the Galveston L-rod technique. The pelvic ring was then reestablished by means of a threaded rod connecting left and right ilia. Both autologous (posterior iliac crest) and allograft bone were used for fusion, and a tibial allograft strut was placed between the remaining ilia. The patients were immobilized for 8 weeks postoperatively and underwent progressive rehabilitation. At the 1-year follow-up review, one patient could walk unassisted, and the other ambulated independently using a cane. Both patients controlled bowel function satisfactorily with laxatives and diet and could maintain continence but required self-catheterization for bladder emptying. The authors conclude that in selected patients, total sacrectomy represents an acceptable surgical procedure that can offer not only effective local pain control, but also a potential cure, while preserving satisfactory ambulatory capacity and neurological function.

Authors+Show Affiliations

Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

9347991

Citation

Gokaslan, Z L., et al. "Total Sacrectomy and Galveston L-rod Reconstruction for Malignant Neoplasms. Technical Note." Journal of Neurosurgery, vol. 87, no. 5, 1997, pp. 781-7.
Gokaslan ZL, Romsdahl MM, Kroll SS, et al. Total sacrectomy and Galveston L-rod reconstruction for malignant neoplasms. Technical note. J Neurosurg. 1997;87(5):781-7.
Gokaslan, Z. L., Romsdahl, M. M., Kroll, S. S., Walsh, G. L., Gillis, T. A., Wildrick, D. M., & Leavens, M. E. (1997). Total sacrectomy and Galveston L-rod reconstruction for malignant neoplasms. Technical note. Journal of Neurosurgery, 87(5), 781-7.
Gokaslan ZL, et al. Total Sacrectomy and Galveston L-rod Reconstruction for Malignant Neoplasms. Technical Note. J Neurosurg. 1997;87(5):781-7. PubMed PMID: 9347991.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Total sacrectomy and Galveston L-rod reconstruction for malignant neoplasms. Technical note. AU - Gokaslan,Z L, AU - Romsdahl,M M, AU - Kroll,S S, AU - Walsh,G L, AU - Gillis,T A, AU - Wildrick,D M, AU - Leavens,M E, PY - 1997/11/5/pubmed PY - 1997/11/5/medline PY - 1997/11/5/entrez SP - 781 EP - 7 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 87 IS - 5 N2 - Although radical resection is the best treatment for malignant sacral tumors, total sacrectomy for such tumors has been performed in only a few instances. Total sacral resection requires reconstruction of the pelvic ring plus establishment of a bilateral union between the lumbar spine and iliac bone. This technique is illustrated in two patients harboring large, painful, sacral giant-cell tumors that were unresponsive to prior treatment. These patients were treated with complete en bloc resection of the sacrum and complex iliolumbar reconstruction/stabilization and fusion. Surgery was performed in two stages, the first consisting of a midline celiotomy, dissection of visceral/neural structures, and ligation of internal iliac vessels, followed by an anterior L5-S1 discectomy. The second stage consisted of mobilization of an inferiorly based myocutaneous rectus abdominis pedicle flap for wound closure, followed by an L-5 laminectomy, bilateral L-5 foraminotomy, ligation of the thecal sac, division of sacral nerve roots, and transection of the ilia lateral to the tumor and sacroiliac joints. Placement of the instrumentation required segmental fixation of the lumbar spine from L-3 down by means of pedicle screws and the establishment of a bilateral liaison between the lumbar spine and the ilia by using the Galveston L-rod technique. The pelvic ring was then reestablished by means of a threaded rod connecting left and right ilia. Both autologous (posterior iliac crest) and allograft bone were used for fusion, and a tibial allograft strut was placed between the remaining ilia. The patients were immobilized for 8 weeks postoperatively and underwent progressive rehabilitation. At the 1-year follow-up review, one patient could walk unassisted, and the other ambulated independently using a cane. Both patients controlled bowel function satisfactorily with laxatives and diet and could maintain continence but required self-catheterization for bladder emptying. The authors conclude that in selected patients, total sacrectomy represents an acceptable surgical procedure that can offer not only effective local pain control, but also a potential cure, while preserving satisfactory ambulatory capacity and neurological function. SN - 0022-3085 UR - https://www.unboundmedicine.com/medline/citation/9347991/Total_sacrectomy_and_Galveston_L_rod_reconstruction_for_malignant_neoplasms__Technical_note_ L2 - https://thejns.org/doi/10.3171/jns.1997.87.5.0781 DB - PRIME DP - Unbound Medicine ER -