Abstract
ObjectiveTo investigate the efficacy and safety of spinopelvic reconstruction based on a novel suspended, modular, and 3D‐printed total sacral implant after total piecemeal resection of a sacral giant cell tumor (SGCT) with the preservation of bilateral S1–3 nerve roots via a posterior‐only approach.MethodsFive patients who had undergone total piecemeal resection of SGCT involving upper sacral segments (S1 and S2) and the midline with the preservation of bilateral S1–3 nerve roots via a posterior‐only approach between September 2017 and July 2018 were retrospectively reviewed. A novel suspended, modular, and 3D‐printed total sacral implant had been used for reconstruction. This series included two female and three male patients, with a mean age of 42.2 years (range, 31–53 years). Surgical time, blood loss, complications, preoperative and postoperative neurological function, instrumentation failure, and local control were presented and analyzed.ResultsAll patients underwent the operation without death or serious complications. The implant was installed on the defect, connecting the ilium and lumbar vertebrae, and fixed with a screw–rod system up to the level of L3–4 or L4–5. The mean operative time was 502 min (range, 360–640 min) and the mean operative blood loss 4400 mL (range, 3000–7000 mL). The mean follow‐up was 15 months. After the operation, pain was significantly relieved, and the patients resumed walking as early as 2 weeks later. The patients showed no neurogenic bladder dysfunction and no fecal incontinence or gait disturbance. Wound healing was poor in one patient. Patients recovered well without evidence of local recurrence. No implant failures or related clinical symptoms were detected during follow up. Satisfactory bone ingrowth and osseointegration at the bone‐implant junctions was found in follow‐up CT.ConclusionAlthough technically challenging, it is feasible and safe to use a suspended, modular, and 3D‐printed implant for reconstruction after total piecemeal resection with the preservation of bilateral S1–3 nerve roots in patients with SGCT. We believe that this implant can be applied to sacral reconstruction in a wide variety of diseases.
Highlights
A novel suspended, modular, and 3D-printed total sacral implant had been used for reconstruction
Giant cell tumor of the bone is a locally aggressive benign bone tumor that rarely metastasizes to the lungs, with malignant transformation occurring in fewer than 1% of all giant cell tumors of the bone (GCTB)[1]
With the blockade of the preserved nerve root, the previously used one-piece implant is difficult to place. To overcome these limitations, we describe a novel suspended, modular, and
Summary
Giant cell tumor of the bone is a locally aggressive benign bone tumor that rarely metastasizes to the lungs, with malignant transformation occurring in fewer than 1% of all giant cell tumors of the bone (GCTB)[1]. Sacral giant cell tumors (SGCT) have no specific symptoms in the early stages and are often quite large at diagnosis. Surgical resection is necessary to improve local control and survival for patients with giant cell tumors of the bone. Surgical management of SGCT is challenging because of the large size of the tumors, massive bleeding, spinal instability, and involvement of sacral nerve roots. Some giant cell tumors (GCT) involve the upper sacral segments, frequently crossing the midline and even the sacroiliac joint. Definitive treatment guidelines for SGCT have not been established[2]. The optimal treatment of SGCT remains controversial[3]. Surgery with wide margins results in a significant decrease in the local recurrence rate, wide resection often requires the sacral nerve roots to be sacrificed and there is significant risk of postoperative neurological damage[4]. Total piecemeal resection is a viable alternative if total en bloc resection, which is associated with an excellent prognosis, is unfeasible
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