Midsacrectomies for Sacral Tumors in Combination with Standalone Sacropelvic Fixation Shields Against Development of Sacral Insufficiency Fractures at Long-term Follow-up
Clinical Spine Fellow Northwell Health Manhasset, NY, US
Disclosure(s):
Jeffrey H. Zimering, MD: No financial relationships to disclose
Introduction: The surgical management of sacral tumors is demanding and requires an appreciation of the biomechanical consequences to sacropelvic stability after resection. Transverse partial, midsacrectomies (distal S1 vertebral body to S2-S3 disc space) for tumor resection offer the greatest ability for local tumor control, progression-free disease, and improved overall survival. However, in the absence of spinopelvic instrumented stabilization after midsacrectomy, 16-33% of patients suffer sacral insufficiency fractures in the residual sacrum. Previously, our group devised a novel, standalone sacropelvic fixation technique with midsacrectomy to avoid mobile lumbar segment fusion and to buffer against post-operative sacral insufficiency fractures. Here, we report on the long-term outcomes of sacropelvic stability after midsacrectomy with our technique in patients who underwent tumor resection.
Methods: We retrospectively reviewed medical records of all patients who underwent midsacrectomy for tumor resection with concomitant standalone sacropelvic fixation at a tertiary comprehensive cancer center between 2022 and 2024. Baseline characteristics and outcome data were collected. The primary outcome was presence of sacral insufficiency fractures at most recent radiographic follow-up.
Results: Ten patients (7 male, 3 female), median age 59 years, underwent midsacrectomy with concurrent standalone sacropelvic fixation. Median BMI was 24 kg/m2. In 60% of patients, tumor pathology was chordoma. Median operative time was 444.5 minutes and median post-operative length of stay was 8 days. Median clinical follow-up was 520 days (range 58-833 days), and median radiographic follow-up was 618.5 days (range 71-807 days). Zero patients had sacral insufficiency fractures during entire follow-up period.
Conclusion : Our data suggests that midsacrectomy paired with standalone sacropelvic fixation for sacral tumor resection shields against the short and long-term development of sacral insufficiency fractures and plays a central role in the maintenance of lumbar motion-preserving sacropelvic stability.