P. Wuisman et al., Reconstruction after total en bloc sacrectomy for osteosarcoma using a custom-made prosthesis - A technical note, SPINE, 26(4), 2001, pp. 431-439
Study Design: A report of an innovative technique to restore the lumbosacra
l junction after resection of primary highly malignant osteosarcoma of the
sacrum involving the whole sacrum, soft tissues, and adjacent posterior par
ts of both iliac wings.
Objectives: To describe the planning and design of a custom-made sacral pro
sthesis, the surgical technique, and clinical and functional outcome of the
patient.
Summary of Background Data: Although there have been case reports about rec
onstruction methods after total sacrectomy, to date, there has not been a r
eported clinical case of successful reconstruction using an individual desi
gned prosthesis based on a three-dimensional real-sized model.
Methods: A 42-year-old woman was referred with progressive neurologic impai
rment due to primary osteosarcoma of the sacrum invading surrounding struct
ures. Based on a three-dimensional tea I-sized model, a detailed surgical p
lan was developed to assure safe, wide surgical margins. In addition, the m
odel enabled design and testing of a custom-made sacral prosthesis, to prov
ide stable lumbosacral reconstruction.
Results: After induction chemotherapy, a staged anteroposterior resection-r
econstruction was successfully performed. After surgery, a superficial woun
d dehiscence was promptly treated. Within 3 weeks after surgery, mobilizati
on began, and the adjuvant chemotherapy was continued. At the 36-month foll
ow-up, the patient was disease free, had a stable, painless spinopelvic jun
ction, and could walk short distances using ankle orthoses and crutches. Ra
diographs show complete incorporation of the pelvic grafts and unchanged po
sition of the implant.
Conclusions: In planning and performing a total sacrectomy, including subst
antial parts of iliac wings, a three-dimensional real-sized model offers su
rgeons distinct advantages. Wide bony resection margins can be drawn on the
model, and an individual custom-made prosthesis to re-establish spinopelvi
c continuity can be designed and tested before the intervention.