title: En bloc hemisacrectomy and internal hemipelvectomy via the posterior approach.
abstract: OBJECTIVE
  Traditionally, hemisacrectomy and internal hemipelvectomy procedures have required both an anterior and a posterior approach. A posterior-only approach has the potential to complete an en bloc tumor resection and spinopelvic reconstruction while reducing surgical morbidity.
  
  
  METHODS
  The authors describe 3 cases in which en bloc resection of the hemisacrum and ilium and subsequent lumbopelvic and pelvic ring reconstruction were performed from a posterior-only approach. Two more traditional anterior and posterior staged procedures are also included for comparison.
  
  
  RESULTS
  In all 3 cases, an oncologically appropriate surgery and spinopelvic reconstruction were performed through a posterior-only approach.
  
  
  CONCLUSIONS
  The advantage of a midline posterior approach is the ability to perform a lumbosacral reconstruction, necessary in cases in which the S-1 body is iatrogenically disrupted during tumor resection.
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Clarke
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Zadnik
authors.forename: Mari L
authors.initials: ML
authors.lastname: Groves
authors.forename: Hormuzdiyar H
authors.initials: HH
authors.lastname: Dasenbrock
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Wesley
authors.initials: W
authors.lastname: Hsu
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
mesh_terms: D000328:Adult; D000368:Aged; D002813:Chondrosarcoma / Q000473:pathology / Q000601:surgery*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D017809:Fatal Outcome; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000473:pathology / Q000601:surgery*; D006428:Hemipelvectomy / Q000379:methods*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000556:secondary / Q000601:surgery*; D012447:Sacrum / Q000601:surgery*; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*; D055815:Young Adult
keywords: ASIS = anterior superior iliac spine; PSIS = posterior superior iliac spine; SI = sacroiliac; hemisacrectomy; internal hemipelvectomy; lumbosacral reconstruction; posterior approach; sacral