Abstract
Background: To provide patients with a superior quality of life (QOL) after their pelvic tumor resection, ensuring the stability of the trunk as well as satisfactory lower extremity function is important. Although microsurgical reconstructions for the pelvic ring and hip are used clinically, the details of postoperative long-term spinal deformity and QOL remain unclear. Methods: The patients were 66- and 43-year-old men and a 43-year-old woman. The mean postoperative follow-up period was 134 months. The surgical procedures performed on these patients were: pelvic ring reconstruction using a double-barreled free vascularized fibular graft (FVFG) in Patient 1; simultaneous pelvic ring reconstruction using FVFG and hip arthrodesis in Patient 2; and latissimus dorsi free flap without pelvic ring reconstruction in Patient 3. As indicators of spinal deformity, we measured the Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, pelvic angle on the sagittal plane, and sagittal plane balance using whole spine radiography. To assess the patients’ QOL, we examined the International Society of Limb Salvage (ISOLS) score, the Roland-Morris Disability Questionnaire (RDQ), activities of daily living (ADL) satisfaction using a visual analogue scale (VAS), and the SF-36. Results: Spinal alignment in the frontal plane worsened in order from Patient 1 to 3. Spinal alignment and pelvic tilt in the sagittal plane were at appropriate levels in Patients 1 and 2. The trunk tilt in the sagittal plane was at an appropriate level only in Patient 1. In the QOL assessment, the function of the affected limb worsened in order from Patient 1 to 3. RDQ scores were lower than the national norm in Patients 2 and 3. With respect to ADL satisfaction and the SF-36, Patient 3 had a markedly low VAS, physical functioning, role-physical, and role-emotional scores. Conclusion: In the long-term clinical course after pelvic tumor resection, in order to obtain satisfactory spinal alignment and QOL, pelvic ring reconstruction and hip arthrodesis are important.
Highlights
After an individual undergoes a pelvic tumor resection, it is important that he or she achieves adequate trunk support as well as satisfactory lower extremity function in order to gain an adequate quality of life (QOL) [1]
In the present study we investigated the cases of three patients who underwent different reconstructive surgeries that used microsurgery after pelvic tumor resection ≥10 years ago, and we evaluated the effects of reconstructed pelvic ring and hip function on spinal deformity and QOL
thoracic kyphosis angle (TKA) and lumbar lordosis angle (LLA) The TKAs were 38 ̊, 32 ̊, and 4 ̊ and the LLAs were 49 ̊, 44 ̊, and 7 ̊ for Patients 1, 2, and 3, respectively, indicating that the physiological curvature of the spine decreases with disruption of the pelvic ring and hip
Summary
After an individual undergoes a pelvic tumor resection, it is important that he or she achieves adequate trunk support as well as satisfactory lower extremity function in order to gain an adequate quality of life (QOL) [1]. In the present study we investigated the cases of three patients who underwent different reconstructive surgeries that used microsurgery after pelvic tumor resection ≥10 years ago, and we evaluated the effects of reconstructed pelvic ring and hip function on spinal deformity and QOL. To provide patients with a superior quality of life (QOL) after their pelvic tumor resection, ensuring the stability of the trunk as well as satisfactory lower extremity function is important. Microsurgical reconstructions for the pelvic ring and hip are used clinically, the details of postoperative long-term spinal deformity and QOL remain unclear. Conclusion: In the long-term clinical course after pelvic tumor resection, in order to obtain satisfactory spinal alignment and QOL, pelvic ring reconstruction and hip arthrodesis are important
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