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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.
Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].
Show detailsBibliographic details: Bederman SS, Shah KN, Hassan JM, Hoang BH, Kiester PD, Bhatia NN. Surgical techniques for spinopelvic reconstruction following total sacrectomy: a systematic review. European Spine Journal 2014; 23(2): 305-319. [PMC free article: PMC3906440] [PubMed: 24150036]
Abstract
PURPOSE: To identify all available reconstruction methods for a total sacrectomy. Secondarily, we aimed to evaluate outcomes based on different interventions.
METHODS: We searched PubMed to identify sacral resections for tumors requiring internal fixation for stabilization. Demographic information, fixation techniques and postoperative outcomes were abstracted.
RESULTS: Twenty-three publications (43 patients) met inclusion criteria from an initial search of 856 (κ 0.93). Mean age was 37 years and follow-up was 33 months. Fixation methods included a combination of spinopelvic fixation (SPF), posterior pelvic ring fixation (PPRF), and/or anterior spinal column fixation (ASCF). For the purposes of analysis, patients were segregated based on whether they received ASCF. Postoperative complications including wound/instrument infections, GI or vascular complications were reported at a higher rate in the non-ASCF group (1.63 complications/patient vs. 0.7 complications/patient). Instrument failure was seen in 5 (16.1 %) out of the 31 patients with reported outcomes. Specifically, 1 out of 8 patients (12.5 %) with ASCF compared with 4 out of 23 patients (17.4 %) without ASCF had hardware failure. At final follow-up, 35 of 39 patients were ambulating.
CONCLUSION: While surgical treatment of primary sacral tumors remains a challenge, there have been advances in reconstruction techniques following total sacrectomy. SPF has shifted from intrapelvic rod and hook constructs to pedicle and iliac screw-rod systems for improved rigidity. PPRF and ASCF have adapted for deficiencies in the posterior ring and anterior column. A trend toward a lower rate of hardware failure emerged in the group utilizing anterior spinal column support. Despite a more involved reconstruction with ASCF, surgical complications such as infection rates and blood loss were lower compared to the group without ASCF. While we cannot definitively say one system is superior to the other, based on the data gleaned from this systematic review, it is our opinion that incorporation of ASCF in reconstructing the spinopelvic junction may lead to improved outcomes. However, most importantly, we recommend that the treating surgeon operate on patients requiring a total sacrectomy based on his or her level of comfort, as these cases can be extremely challenging even among experts.
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- Biomechanical comparison of spinopelvic reconstruction techniques in the setting of total sacrectomy.[Spine (Phila Pa 1976). 2012]Biomechanical comparison of spinopelvic reconstruction techniques in the setting of total sacrectomy.Mindea SA, Chinthakunta S, Moldavsky M, Gudipally M, Khalil S. Spine (Phila Pa 1976). 2012 Dec 15; 37(26):E1622-7.
- Review Fixation techniques for complex traumatic transverse sacral fractures: a systematic review.[Spine (Phila Pa 1976). 2013]Review Fixation techniques for complex traumatic transverse sacral fractures: a systematic review.Bederman SS, Hassan JM, Shah KN, Kiester PD, Bhatia NN, Zamorano DP. Spine (Phila Pa 1976). 2013 Jul 15; 38(16):E1028-40.
- Surgical techniques for spinopelvic reconstruction following total sacrectomy: a...Surgical techniques for spinopelvic reconstruction following total sacrectomy: a systematic review - Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews
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