title: Creation of false pedicles and a neo-pelvis for lumbopelvic reconstruction following en bloc resection of an iliosacral chondrosarcoma with lumbar spine extension: technical note.
abstract: En bloc resection with negative tumor margins remains the principal treatment option for control or cure of primary pelvic chondrosarcomas, as current adjuvant therapies remain ineffective. Iliosacral chondrosarcomas with involvement of the sciatic notch are sufficiently challenging tumors. However, when there is concomitant lumbar extension requiring resection of the pedicles to maintain negative surgical margins, transpedicular screw fixation is not possible, making reconstruction of the lumbopelvic junction extremely challenging. A patient with an iliosacral chondrosarcoma with lumbar spine extension is presented in this report to illustrate a novel lumbopelvic spinal construct. Following combined external pelvectomy and hemisacrectomy with contralateral L3-5 hemilaminectomy and ipsilateral pediculotomy, bicortical transvertebral body screws were substituted for the missing pedicles, resulting in the creation of "false pedicles," which were further supplemented with an autologous vascularized fibular strut graft from the amputated lower limb and applied to the lateral aspect of the vertebral bodies. The creation of false pedicles allowed for a robust reconstruction of the lumbopelvic junction, including maintaining pelvic ring integrity with a "neo-pelvis", creating a functional load-bearing construct adequate for early mobilization and ambulation. The biomechanical dynamics of this unique construct are also discussed.
authors.affiliation: Departments of Neurological Surgery.
authors.forename: Ehud
authors.initials: E
authors.lastname: Mendel
authors.forename: Narendra
authors.initials: N
authors.lastname: Nathoo
authors.forename: Thomas
authors.initials: T
authors.lastname: Scharschmidt
authors.forename: Carl
authors.initials: C
authors.lastname: Schmidt
authors.forename: James
authors.initials: J
authors.lastname: Boehmler
authors.forename: Joel L
authors.initials: JL
authors.lastname: Mayerson
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D002813:Chondrosarcoma / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging / Q000601:surgery*; D007796:Laminectomy / Q000379:methods; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery*; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed