Soft Tissue and Bone Defect Management in Total Sacrectomy for Primary Sacral Tumors: A Systematic Review with Expert Recommendations

Jeremy Reynolds, Roba Khundkar, Stefano Boriani, Richard Williams, Laurence D. Rhines, Norio Kawahara, Jean Paul Wolinsky, Ziya L. Gokaslan, Peter Varga

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN.: Systematic Review and Expert Consensus OBJECTIVE.: To address the following two questions: (1) Is there a difference in outcomes following spino-pelvic reconstruction of total sacrectomy defects compared to no reconstruction? (2) What constitutes best surgical technique for soft tissue and bony reconstruction after total sacrectomy? SUMMARY OF BACKGROUND DATA.: The management of the soft tissue and bony defect following total sacrectomy for primary sacral tumors remains a challenge due to the complex anatomical relationships and biomechanical requirements. The scarcity of evidence-based literature in this specialised field makes it difficult for the treating surgeon to make an informed choice. METHODS.: A systematic literature review was performed (1950–2015), followed by a meeting of an international expert panel. Medline, Embase, and CINAHL databases and Cochrane Libraries were searched. Using the GRADE guidelines, the panel of experts formulated recommendations based on the available evidence. RESULTS.: 353 studies were identified. Of these, 17 studies were included and were case series. 7 were evaluated as high quality of evidence and 9 were of low quality. There were a total of 116 participants. Three studies included patients (n?=?24) with no spino-pelvic reconstruction. One study included patients (n?=?3) with vascularised bone reconstruction. Twelve studies included patients (n?=?80) with no soft tissue reconstruction, 3 studies described patients with a local flap (n?=?20) and 4 studies with patients having regional flap reconstruction (n?=?16). Patients with or without spino-pelvic reconstruction had similar outcomes with regards to walking; however, most patients in the non-reconstructed group had some ilio-lumbar ligamentous stability preserved. The wound dehiscence and return to theatre rates were higher in patients with no soft tissue reconstruction. CONCLUSION.: We recommend spino-pelvic reconstruction be undertaken with soft tissue reconstruction after total sacrectomy.Level of Evidence: N/A

Original languageEnglish (US)
JournalSpine
DOIs
StateAccepted/In press - Aug 8 2016

ASJC Scopus subject areas

  • Medicine(all)
  • Orthopedics and Sports Medicine
  • Clinical Neurology

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    Reynolds, J., Khundkar, R., Boriani, S., Williams, R., Rhines, L. D., Kawahara, N., Wolinsky, J. P., Gokaslan, Z. L., & Varga, P. (Accepted/In press). Soft Tissue and Bone Defect Management in Total Sacrectomy for Primary Sacral Tumors: A Systematic Review with Expert Recommendations. Spine. https://doi.org/10.1097/BRS.0000000000001834