Scoliosis after extended hemipelvectomy.
METHODS
Retrospective review plus 2 representative case reports.


OBJECTIVE
To evaluate the prevalence of scoliosis after extended hemipelvectomy (EH) and illustrate the problem's severity.


BACKGROUND
No published series has analyzed this problem. Data are needed to decide the potential need for and timing of spine fusion in these patients.


METHODS
We treated 14 patients with EH over 10 years. Mean age was 47 years. Diagnoses included osteosarcoma (6); chondrosarcoma (4); metastatic cancer (2); and MFH and undifferentiated sarcoma (1 each). Operating time ranged from 7 to 15 hours, and mean estimated blood loss was 8 L. Patients were observed for scoliosis, functional results, and for oncological outcome (survival, disease progression). Two patients who became scoliotic after EH illustrate the problem: a 31-year-old man underwent EH for pelvic osteosarcoma and progressively developed a painful 44° scoliotic curve; and a 27-year-old woman who developed a 60° painful scoliotic curve and radiculopathy years after EH including L5-S1 disc disruption.


RESULTS
Of 12 patients, 8 died within 7 months of EH. Only 2 of 12 patients are long-term survivors free of disease (3 and 6 years after surgery), and 2 are alive with disease more than 1 year after surgery. In patients >1 year survival, 3 of 4 patients had curves greater than 20°. Of 10 evaluable patients, 2 developed a curve greater than 30° that warranted fusion. Four others had curves between 20° and 30°. Of these 6, 5 developed a sharp-angled lumbar curve with the concavity away from the operated side. Risk factors for symptomatic scoliosis after EH include disc disruption, paraspinal muscle/ligament resection, or facetectomies in ambulatory patients with a lengthy survival.


CONCLUSIONS
Primary spinal fixation should be avoided because of the high morbidity and early mortality of EH. Selected high-risk patients can be stabilized later if they develop painful instability.
Memorial Sloan-Kettering Cancer Center, Affiliated with Weill Medical College of Cornell University, New York, NY 10021, USA.
Ioannis
I
Papanastassiou
Patrick J
PJ
Boland
Oheneba
O
Boachie-Adjei
Carol D
CD
Morris
John H
JH
Healey
D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D006428:Hemipelvectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000601:surgery; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology*; D013131:Spine / Q000601:surgery; D016896:Treatment Outcome