En bloc total sacrectomy performed in a single stage through a posterior approach.
OBJECTIVE
Total sacrectomies are performed for extensive en bloc tumor resections. Exposure traditionally combines a posterior approach with a laparotomy to facilitate vascular control. We present a case of a total en bloc sacrectomy performed entirely through the posterior approach, thereby avoiding the need for a laparotomy.


METHODS
A 57-year-old man presented with sacral pain and loss of bowel and bladder function. A large sacral mass was identified and submitted to biopsy. Results were consistent with an osteoblastoma, although osteosarcoma could not be excluded on pathological examination. The patient was taken to the operating room for a total sacrectomy and en bloc resection of the mass.


METHODS
Lateral iliac osteotomies were performed, followed by an L5-S1 discectomy and resection of the annulus, thus mobilizing the sacrum. Gradual distraction of the interspace coupled with upward traction of the sacrum provided an anterior exposure through which the internal iliac vessels were controlled, dissected, and divided. A combined transperineal approach completed the posterior dissection and the tumor was delivered en bloc. Lumbopelvic reconstruction was performed simultaneously.


CONCLUSIONS
With the use of interspace distraction and sacral elevation to facilitate vascular control, a total sacrectomy was performed without the need for the anterior exposure of a laparotomy.
McLoughlin
Gregory S
GS
Division of Neurosurgery, University of Saskatchewan, Royal University Hospital, Saskatoon, Canada.
Sciubba
Daniel M
DM
Suk
Ian
I
Witham
Timothy
T
Bydon
Ali
A
Gokaslan
Ziya L
ZL
Wolinsky
Jean-Paul
JP
D006801:Humans; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000601:surgery; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D012447:Sacrum / Q000000981:diagnostic imaging* / Q000601:surgery*