The Use of Anterior Lumbosacral Interbody Fusion in Spinopelvic Stabilization After High Partial Sacrectomy

2019 ◽  
Vol 17 (4) ◽  
pp. E173-E176
Author(s):  
Osama N Kashlan ◽  
David K Monson ◽  
Daniel Refai
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Leg Pain ◽  
Bony Defect ◽  
Nerve Roots ◽  
En Bloc ◽  
Tumor Margins ◽  
Sacral Tumor ◽  
Superior Portion ◽  
Total Sacrectomy

Abstract BACKGROUND AND IMPORTANCE Traditionally, when a patient presents with a midline chordoma with extension to the mid-S1 body where neither S1 nerve roots can be spared, the recommendation would be to perform a total sacrectomy for en bloc resection. This procedure, however, results in a large bony defect that makes it difficult to achieve fusion across the lumbosacral and sacroiliac junction (SIJ). To help prevent this challenge in the situation described above, we propose performing a high sacrectomy for en bloc resection with placement of an anterior L5-S1 graft instead in specific situations where the tumor extends to the mid-S1 body leaving the superior aspect of S1 unaffected. CLINICAL PRESENTATION A 56-yr-old female presented to our clinic with back pain, leg pain, urinary incontinence, and perineal numbness. She was found to have a chordoma that extended to the mid-S1 body superiorly. Her S1 nerve roots were involved extraforaminally. We performed the operation described above with no signs of hardware malfunction or tumor recurrence at 5 mo. CONCLUSION In patients where the sacral tumor that involves the S1 nerve roots but does not involve the superior portion of the S1 body, there continues to be unaffected SIJ to allow for arthrodesis, and an anterior approach is necessary for other indications, we recommend performing a high partial sacrectomy with placement of an anterior L5-S1 graft rather than a total sacrectomy as long as the bony resection offers ability to obtain tumor margins.

Long-term Outcomes Following En Bloc Resection for Sacral Tumor: A Retrospective Analysis of 93 Cases

Orthopedics ◽  
2011 ◽  
Author(s):  
Zhi-yu Zhang ◽  
Chang-feng Fu ◽  
Ying-xin Yang ◽  
Li-qiang Wang ◽  
Yan Cui ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Long Term Outcomes ◽  
En Bloc ◽  
Sacral Tumor

scholarly journals Surgical treatment of a clival-C2 atypical teratoid/rhabdoid tumor

2010 ◽  
Vol 5 (1) ◽  
pp. 75-79 ◽  
Author(s):  
Gregory G. Heuer ◽  
Heather Kiefer ◽  
Alexander R. Judkins ◽  
Jean Belasco ◽  
Jaclyn A. Biegel ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Metastatic Lesion ◽  
Bloc Resection ◽  
Conus Medullaris ◽  
Rhabdoid Tumor ◽  
Leg Pain ◽  
Atypical Teratoid Rhabdoid Tumor ◽  
En Bloc ◽  
Initial Surgery ◽  
Atypical Teratoid

The authors present the case of en bloc resection of a clival-C2 atypical teratoid/rhabdoid tumor. These aggressive lesions of early childhood generally occur in the cerebellum or cerebral hemispheres. This 7-year-old boy presented with pain on turning his head and was found to have a clival-C2 mass. A metastatic workup was negative for disseminated disease. A transoral biopsy procedure revealed an atypical teratoid/rhabdoid tumor on histological examination. The tumor was resected via a transoral approach, and the patient's spine was stabilized with posterior instrumented fusion from the occiput to C-5. Postoperatively, the patient underwent 16 months of chemotherapy along with 6 weeks of overlapping radiation therapy. Twenty-seven months after the initial surgery he presented with leg pain and was found to have a solitary metastatic lesion at the conus medullaris. There was no local recurrence at the clivus. The conus tumor was resected and found to be consistent with the primary tumor. Several months later the patient presented with disseminated intrathecal disease and ultimately died 42 months after the initial resection.

Parasagittal osteotomy for en bloc resection of multilevel cervical chordomas

2009 ◽  
Vol 10 (5) ◽  
pp. 397-403 ◽  
Author(s):  
Dean Chou ◽  
Frank Acosta ◽  
Jordan M. Cloyd ◽  
Christopher P. Ames
Keyword(s):  
Case Reports ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Tumor Removal ◽  
Nerve Roots ◽  
En Bloc ◽  
Term Survival ◽  
Cervical Chordoma ◽  
Disease Free

En bloc resection of chordoma has been shown to be critical for prolonging long-term survival and disease-free intervals in patients. Cervical spine chordomas pose special challenges because of the vertebral arteries and critical nerve roots involved. Multilevel chordomas pose even greater challenges because of the need to remove multiple segments of the spine in 1 piece without tumor violation. Although there have been 2 case reports describing multilevel spondylectomy for cervical chordoma, to the authors' knowledge, there are no reports of parasagittal osteotomies for en bloc resection of multilevel cervical chordomas. The use of these osteotomies allows us to avoid intralesional resection and adhere to the oncological principle of en bloc tumor excision. The authors report their management of 3 multilevel cervical chordomas and describe their technique of en bloc tumor removal using parasagittal osteotomy.

Lumbopelvic Reconstruction After Combined L5 Spondylectomy and Total Sacrectomy for En Bloc Resection of a Malignant Fibrous Histiocytoma

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. E498-E502 ◽  
Author(s):  
Gary L. Gallia ◽  
Ian Suk ◽  
Timothy F. Witham ◽  
Susan L. Gearhart ◽  
James H. Black ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Myocutaneous Flap ◽  
Treatment Options ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Reconstruction Technique ◽  
Intractable Pain ◽  
En Bloc ◽  
Total Sacrectomy ◽  
Vertebral Segment

Abstract BACKGROUND Primary sacral neoplasms that extend superiorly to involve the distal lumbar spine represent complex surgical problems. Treatment options for these patients are often limited to hemicorporectomy. OBJECTIVE To detail our surgical technique for en bloc resection of a sarcoma involving the L5 vertebral segment and sacrum and the reconstruction of the lumbopelvic junction. METHODS A 52-year-old woman presented with intractable pain secondary to a sarcoma involving the L5 vertebral segment and sacrum. She underwent a combined L5 spondylectomy and total sacrectomy for en bloc resection of her neoplasm. A novel lumbopelvic reconstruction technique was used to establish a liaison between the lumbar spine and pelvis. RESULTS Operative complications included a venous vascular injury and a nonviable myocutaneous flap. Postoperatively, the patient had complete resolution of her pain. Unfortunately, the patient developed metastatic disease and died 5 months after her initial surgical procedure. CONCLUSION We describe a patient who underwent a combined L5 spondylectomy and total sacrectomy for en bloc resection of a lumbosacral sarcoma. Additionally, we report a novel technique to reconstruct the lumbopelvic junction. The operative procedures are detailed with the aid of radiographs, intraoperative photographs, and illustrations.

Conversion of high sacral to midsacral amputation via S-2 nerve preservation during partial S-2 sacrectomy for chordoma

2014 ◽  
Vol 20 (4) ◽  
pp. 421-429 ◽  
Author(s):  
Rajiv Saigal ◽  
Daniel C. Lu ◽  
Donna Y. Deng ◽  
Dean Chou
Keyword(s):  
Sexual Function ◽  
Functional Outcome ◽  
Nerve Root ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Nerve Roots ◽  
En Bloc ◽  
Risk Of Recurrence ◽  
Nerve Preservation ◽  
Sacral Chordoma

Chordomas of the sacrum require en bloc resection to reduce the risk of recurrence, but this may sacrifice nerves vital to bladder, bowel, and sexual function. High, mid-, and low sacral amputations have been previously classified based on nerve root sacrifice, not bony amputation. Sacrifice of the S-2 nerves or those above results in a high sacral amputation, but preserving the S-2 nerves converts it into a midsacral amputation. Preservation of the S-2 nerves has been shown to improve functional outcome, despite the bony osteotomy being unchanged. Thus, keeping the same bony amputation while preserving the S-2 nerve roots may allow for improved functional outcome while still achieving the same goal of oncological resection. Preservation of the S-2 nerves may be particularly difficult during amputation at the S-2 pedicle or above, and the authors describe their technique for preserving the S-2 nerves during partial sacrectomy at or just above the S-2 pedicle. Four cases of sacral chordoma resections are presented to illustrate the technique.

Total cervical spondylectomy for primary osteogenic sarcoma

2002 ◽  
Vol 97 (3) ◽  
pp. 386-392 ◽  
Author(s):  
Zvi R. Cohen ◽  
Daryl R. Fourney ◽  
Rex A. Marco ◽  
Laurence D. Rhines ◽  
Ziya L. Gokaslan
Keyword(s):  
Cervical Spine ◽  
Osteogenic Sarcoma ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Nerve Roots ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
Content Type ◽  
Bloc Spondylectomy ◽  
Thoracic And Lumbar Spine

✓ The authors describe a technique for total spondylectomy for lesions involving the cervical spine. The method involves separately staged anterior and posterior approaches and befits the unique anatomy of the cervical spine. The procedure is described in detail, with the aid of radiographs, intraoperative photographs, and illustrations. Unlike in the thoracic and lumbar spine—for which methods of total en bloc spondylectomy have previously been described—a strictly en bloc resection is not possible in the cervical spine because of the need to preserve the vertebral arteries and the nerve roots supplying the upper limbs. Although the resection described in this case is by definition intralesional, it is oncologically sound, given the development of effective neoadjuvent chemotherapeutic regimens for osteosarcoma.

Use of Navigated Ultrasonic Bone Cutting Tool for En Bloc Resection of Thoracic Chondrosarcoma: Technical Report

2020 ◽  
Vol 19 (5) ◽  
pp. 551-556
Author(s):  
Aditya Vedantam ◽  
Krishanthan Vigneswaran ◽  
Ganesh Rao ◽  
Garrett L Walsh ◽  
Laurence D Rhines ◽  
...  
Keyword(s):  
New York ◽  
Real Time ◽  
Image Guidance ◽  
Cutting Tool ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Intraoperative Computed Tomography ◽  
Tumor Margins ◽  
Vertebral Bodies

Abstract BACKGROUND En bloc surgical resection with wide margins offers the best local control rates for chondrosarcoma of the spine. OBJECTIVE To describe the surgical technique for en bloc resection of a large thoracic chondrosarcoma using image guidance for a complex osteotomy with an ultrasonic bone cutting device (Misonix, Farmingdale, New York). METHODS A 2-stage procedure was performed for resection of a thoracic chondrosarcoma involving the T3-T7 vertebral bodies. During the first stage, a posterior approach, the ultrasonic bone cutter was precisely navigated to perform an intralaminar osteotomy as well as a multilevel split sagittal osteotomy through the vertebral bodies. In the second stage, a transthoracic approach was used to complete the en bloc resection of the specimen. Intraoperative frozen sections from the surgical margins were negative for tumor. RESULTS The ultrasonic bone cutting device was navigated based on coregistration of the intraoperative computed tomography (CT) images and preoperative magnetic resonance imaging (MRI). Real-time navigation using coregistered images enabled identification of tumor margins within the bone and adjacent soft tissue allowing precise execution of the intralaminar and multilevel split sagittal vertebral osteotomies. Surgical video demonstrates the utility of real-time navigation to properly identify the tumor margins and guide the ultrasonic bone cutting tool during the osteotomies. CONCLUSION We describe the use of image guidance to navigate an ultrasonic bone cutting tool for a complex en bloc resection of a multilevel thoracic spine chondrosarcoma.

Midsacral Amputation for En Bloc Resection of Chordoma

2010 ◽  
Vol 66 (suppl_1) ◽  
pp. ons-41-ons-44 ◽  
Author(s):  
Ganesh Rao ◽  
George J. Chang ◽  
Ian Suk ◽  
Ziya Gokaslan ◽  
Laurence D. Rhines
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Surgical Margins ◽  
En Bloc ◽  
Sacral Chordoma ◽  
Sacral Tumor ◽  
Tumors Of The Sacrum ◽  
Successful Removal ◽  
Sacral Tumors

Abstract Background: En bloc resection, with adequate surgical margins, of primary malignant bone tumors of the sacrum is associated with long term disease control and potential cure. Resection of sacral tumors is difficult due to the proximity of neurovascular and visceral structures, and complete, or even partial, sacrectomy often results in functional loss for the patient. Objective: We describe the technique for en bloc resection of a sacral chordoma through a mid-sacral amputation. Results: We demonstrate successful removal of a large sacral tumor with wide surgical margins while preserving neurologic function. Conclusion: This technique for midsacral amputation to remove a sacral tumor en bloc minimizes local recurrence and maximizes neurovascular function.

Three-Level En Bloc Spondylectomy for Chordoma

2011 ◽  
Vol 68 (suppl_2) ◽  
pp. ons325-ons333 ◽  
Author(s):  
Michelle J. Clarke ◽  
Wesley Hsu ◽  
Ian Suk ◽  
Edward McCarthy ◽  
James H. Black ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
En Bloc Spondylectomy ◽  
Tumor Margins ◽  
Bloc Spondylectomy ◽  
Negative Tumor ◽  
Neurologically Intact ◽  
Neurovascular Structures

Abstract Background: En bloc resection of spinal and sacral chordomas may convey a survival benefit. However, these procedures often are complex and require the surgeon to plan a procedure that results in negative tumor margins, protects vital neurovascular structures, and concludes with a viable biomechanical reconstruction. Objective: We present a case of a 3-level en bloc lumbar spondylectomy and reconstruction. Methods: A case of a 45-year-old woman with biopsy-proven exophytic L4 chordoma is presented. The patient underwent successful L3-L5 en bloc spondylectomy and reconstruction over 3 stages. Results: The patient did well following the procedure, and was neurologically intact at 6-week follow-up. Conclusion: Three-level en bloc spondylectomy with lumbopelvic reconstruction is a challenging yet feasible procedure.

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