Computer-Assisted Sacral Tumor Resection

Abstract

Resection of sacral tumors is one of the most difficult operations in orthopaedic oncology because complex anatomy and important internal organs in the pelvic area make it difficult to achieve wide surgical margins1. Wide resection of sacral tumors may lead to serious functional impairments due to injury to important internal organs and/or the lumbosacral nerve roots or through the disruption of load-bearing through the sacroiliac joint. Recent advances in diagnostic modalities facilitate better surgical planning and can help in the performance of surgeries as planned. Computer-assisted surgery has been used in orthopaedic operations such as cruciate ligament reconstruction, hip and knee arthroplasty, and pedicle screw placement. The main advantage of computer-assisted navigation over other imaging modalities is that intraoperative identification can increase the accuracy of surgical resection. We report a case of sacral chondrosarcoma in which computer-assisted surgery provided intraoperative real-time imaging, thereby allowing us to achieve adequate surgical margins while preserving the sacral nerve roots. Additionally, the tumor resection was carried out through a posterior approach only. The patient was informed that data concerning the case would be submitted for publication, and he consented. A fifty-two-year-old man was referred to us with a longer than five-month history of a dull pain in the lower back. There was no evidence of a neurologic deficit in the lumbosacral nerve roots. Systemic symptoms, such as fever or weight loss, were absent. Plain radiographs of the pelvis showed an osteolytic lesion at the right sacral ala. Magnetic resonance imaging revealed that the tumor was located in the right sacral ala, between the sacroiliac joint and the first and second sacral foramina (Fig. 1). Computed tomography revealed cortical destruction of the sacral side of the sacroiliac joint, but there was no evidence of involvement of the ilium. Further evaluation, including computed tomography …