title: Posterior-only approach for en bloc sacrectomy:  clinical outcomes in 36 consecutive patients.
abstract: BACKGROUND
  En bloc resection of primary sacral tumors has a demonstrated survival benefit. Total and high sacral amputations are traditionally performed by using a staged anterior and subsequent posterior approach. However, we have found that en bloc resection and biomechanical reconstruction of the spinal column is possible from a posterior-only approach in many cases.
  
  
  OBJECTIVE
  To assess our series of posterior-only sacrectomies, emphasizing postoperative complications and overall surgical and oncologic outcome.
  
  
  METHODS
  Sixty-nine consecutive patients underwent sacral resections for tumor at our institution between 2004 and 2009. Medical records of all patients were reviewed, and patients were excluded if they had an intentional intralesional resection, hemipelvectomy, or a previous operation. The records of the resulting 36 consecutive patients who underwent primary posterior-only en bloc sacral resections were retrospectively reviewed.
  
  
  RESULTS
  Of the posterior-only patients, all underwent midline posterior approaches for en bloc sacral resection. Sacral amputation was defined by the by sacral root preservation: total (2 cases), high (8 cases), middle (9 cases), low (12 cases), and distal (5 cases). Chordoma was the most common tumor type (30 cases), and surgical margins were marginal in 34 cases and contaminated in 2. Overall, there were 13 complications, including 9 wound infections/revisions. The extent of sacrectomy, and thus the extent of roots sacrificed, correlated with functional outcome.
  
  
  CONCLUSIONS
  It may be possible to perform a posterior-only approach to en bloc sacral resections/reconstructions in patients with tumors that do not extend beyond the lumbosacral junction or invade the bowel requiring bowel resection and diversion.
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Clarke
authors.forename: Hormuzdiyar
authors.initials: H
authors.lastname: Dasenbrock
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Hsieh
authors.forename: Reza
authors.initials: R
authors.lastname: Yassari
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D006801:Humans; D007796:Laminectomy / Q000401:mortality*; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D010027:Osteotomy / Q000401:mortality*; D015995:Prevalence; D018570:Risk Assessment; D012447:Sacrum / Q000601:surgery*; D013125:Spinal Neoplasms / Q000401:mortality* / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult