Spinopelvic Reconstruction Following Lumbosacral tumor Resection

T involving sacral nerve roots and/or bony structures at the lumbosacral junction are challenging to treat surgically due to potential neurological deficits and biomechanical instability following resection (16, 26). However, with the advent of new modern spinal instrumentation, more biomechanically stable lumbosacropelvic constructs can be used. Additionally, with the recent advances in adjuvant chemotherapy and radiation therapy, patients with both primary and some metastatic tumors may be candidates for aggressive surgical intervention. Although metastatic tumors are uncommon in the sacrum or at the lumbosacral junction, there are instances when these complex spinopelvic reconstruction techniques should be used, including treatment of local spread of rectal tumors. For instance, Colibaseanu et al. (5) performed a retrospective study which included 30 patients who had locally aggressive rectal cancer and underwent curative-intent sacropelvic resection. They demonstrated that with the median follow-up of 2.7 years, overall survival at 2 and 5 years was 86% and 46% and disease-free survival at 2 and 5 years was 79% and 43%, which was comparable to patients undergoing nonsacropelvic resections. Additionally, there are other reports of treating metastatic lumbosacral tumors surgically, including myofibroblastic sarcoma (11), neurofibrosarcoma (19), malignant fibrous histiocytoma (8), low-grade malignant peripheral nerve sheath tumor (13), ependymoma and meningioma (6). The objective of this manuscript is to review the biomechanics and complications of different reconstruction techniques. Additionally, the functional and oncological outcomes of these surgical procedures will be discussed.