One‐Step Reconstruction with a Novel Suspended, Modular, and 3D‐Printed Total Sacral Implant Resection of Sacral Giant Cell Tumor with Preservation of Bilateral S1–3 Nerve Roots via a Posterior‐Only Approach

Autor: Zhao‐rui Lv, Zhen‐feng Li, Zhi‐ping Yang, Xin Li, Qiang Yang, Ka Li, Jianmin Li
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Orthopaedic Surgery, Vol 12, Iss 1, Pp 58-66 (2020)
Druh dokumentu: article
ISSN: 1757-7861
1757-7853
DOI: 10.1111/os.12582
Popis: Objective To 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. Methods Five 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. Results All 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. Conclusion Although 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.
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