Decancellation sacral osteotomy in iliosacral tumor resection: a technique for precise sacral margins.
En bloc resection of iliosacral sarcomas is a surgical challenge. There are substantial risks of inadequate margins, local recurrence, and nerve root loss when pelvic sarcomas involve sacral root canals and foramina. The decancellation technique uses principles similar to transpedicle decancellation in spinal deformity correction to perform the sacral osteotomy in iliosacral tumor resection. The technique aims at improving sacral margins and minimizing loss of neural function. We performed a decancellation osteotomy in five patients with sarcomas requiring difficult oblique or sagittal sacral osteotomies and selective root sacrifice. Through laminectomy and without anterior exposure, a precise full-thickness osteotomy of the sacrum was performed without major technique-related morbidities or complications. This was followed by formal pelvic resection and reconstruction. Surgical margins were adequate in all patients and all tumor-free nerve roots were preserved.
Farid
Yasser R
YR
Department of Orthopedic Surgery and Center for Preservation and Transplantation of Musculoskeletal Tissues, Cairo University Hospitals, 47 Iran St Dokki, Giza, Egypt. yassrefarid@yahoo.com
D000293:Adolescent; D001859:Bone Neoplasms / Q000175:diagnosis / Q000601:surgery*; D002675:Child, Preschool; D002813:Chondrosarcoma / Q000175:diagnosis / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium; D008279:Magnetic Resonance Imaging; D008297:Male; D012516:Osteosarcoma / Q000175:diagnosis / Q000601:surgery; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies; D012447:Sacrum; D012512:Sarcoma, Ewing / Q000175:diagnosis / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Cancer. 1996 Aug 15;78(4):745-50
8756367
Instr Course Lect. 2006;55:583-9
16958491
Spine (Phila Pa 1976). 1993 Dec;18(16):2517-22
8303457
J Bone Joint Surg Am. 1999 Mar;81(3):317-25
10199269
J Spinal Disord Tech. 2007 May;20(3):209-15
17473640
J Bone Joint Surg Br. 1990 May;72(3):490-3
2341454
Orthopedics. 1999 Oct;22(10):977-9
10535562
J Bone Joint Surg Am. 1978 Sep;60(6):719-30
701307
J Bone Joint Surg Am. 2001 Nov;83(11):1630-42
11701784
J Bone Joint Surg Am. 1978 Sep;60(6):731-46
701308
J Bone Joint Surg Br. 1999 Sep;81(5):796-802
10530839
Clin Orthop Relat Res. 2005 Sep;438:22-9
16131865
Ann Surg Oncol. 1996 May;3(3):304-9
8726187
Spine (Phila Pa 1976). 2004 Mar 15;29(6):E123-6
15014287
Cancer. 1998 Mar 1;82(5):851-9
9486573
Semin Surg Oncol. 1997 Jan-Feb;13(1):49-54
9025182
Clin Orthop Relat Res. 2003 Feb;(407):152-8
12567142
J Pediatr Hematol Oncol. 2003 Feb;25(2):118-24
12571462
Clin Orthop Relat Res. 1994 Jul;(304):207-17
8020218
J Bone Joint Surg Am. 1989 Apr;71(4):481-94
2703507
Clin Orthop Relat Res. 1998 May;(350):187-94
9602819
Skeletal Radiol. 1991;20(4):279-83
1853221
J Clin Oncol. 1995 Sep;13(9):2336-41
7666092
Clin Orthop Relat Res. 2005 Sep;438:42-50
16131868
Clin Orthop Relat Res. 2002 Apr;(397):12-8
11953590
Clin Orthop Relat Res. 1998 Mar;(348):196-207
9553553
Acta Orthop Scand. 1997 Aug;68(4):381-3
9310044
Arch Orthop Trauma Surg. 1989;108(4):255-60
2774882
Clin Orthop Relat Res. 1969 Sep-Oct;66:6-9
5357786
Clin Orthop Relat Res. 2000 Apr;(373):193-201
10810477