Reconstruction after total en bloc sacrectomy for osteosarcoma using a custom-made prosthesis - A technical note

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.