| Abstrakt: |
Surgical removal of tumors of the sacrum is accompanied by instability of the lumbar spine, pelvic ring and conjunction of thereof. The operation must be finished with fixation of the lumbar spine to the pelvic ring. Traditional fixation of the lumbar spine with a pelvic ring is a long procedure with major disadvantages: 1) long-term bloody stage of open transpedicular fixation on the background of significant blood loss during tumor removal; 2) only 2 fixation points to the iliac bones, which is quite unreliable; 3) need for additional fixation of the iliac bones to each other. This study is conducted to avoid drawbacks of traditional transpedicular fixation after tumors of the sacrum removal by introduction of new minimally invasive spine fixation technique. In 9 patients (first group) operated at the Institute of Neurosurgery from 2015 to 2019 we implement Medtronic Horizon Longitude II minimally invasive system of posterior transpedicular fixation. This system consists of 4-6 screws in the lumbar spine inserted via puncture and 2 screws in each iliac crest set via open access. Second group of 87 cases of sacral tumors removed via posterior access at the same institute in a period from 2005 to 2015 serves as a control. In this group traditional transpedicular systems are used with 4-6 screws in the lumbar spine and 1 screw in each iliac crest both set via open access. Study analysis included spine fixation technique, intraoperative complications, standardized neurological symptoms scoring, CT and MRI data before surgery and at the end of hospital stay. Remote results are assessed in majority of cases. As comparing to traditional spine fixation novel minimally invasive posterior transpedicular fixation significantly reduced intraoperative blood loss from 2.8±0.12 L to 1.3±0.18 L. As we have no complications related to fixation system itself, the reliability of novel fixation systems is comparable to that of traditional ones. Standardized neurological assessment revealed significant improvement in pain, sensory, motor and bladder function scores in both groups at the end of hospital stay as comparing to state before operation. Both groups have comparable scores either before surgery or at the end of hospital stay. Long term results can't be compared due to relatively short period of surveillance of 1.9±0.17 years in the first group comparing to 4.3±0.24 years in the control group. Posterior minimally invasive system of transpedicular fixation has advantages over traditional technology of open spine and pelvic ring fixation consisting in significant reduction of blood loss and, accordingly, intraoperative risk, and reliability of fixation. |
