A biomechanical approach to advances in sacropelvic reconstruction

Abstract

The sacrum is the only mechanical connection between the spine and pelvis/lower extremities. In the setting of a primary, or in select patients a locally advanced recurrent malignancy, curative treatment requires en-bloc sacrectomy. In addition to the surgery in this area being challenging due to the complexity of the pelvic anatomy, adjacent visceral and vascular structures; spinal-pelvic continuity is often lost. Historically following sacral resection patients were left “un-reconstructed” and the spinal column floated between the remaining pelvis, forming a soft-tissue sling which can become painful and lead to a poor patient outcome. Our institution has pioneered a means to reconstruct these defects following high sacral resection in order to restore continuity between the spine, pelvis and femur which has been shown to improve patient outcomes. The purpose of this article is to describe a biomechanical approach to sacral reconstruction.