To evaluate functional and oncological outcomes following sacral resection Retrospective review of 97 sacral tumours referred to spinal or oncology units between 2004 and 2009.Objective
Methods
To evaluate functional and oncological outcomes following resection of sacral tumours and discuss the strategies for instrumentation. Primary malignant tumours of the sacrum are rare, arising from bony or neural elements, or bone marrow in haematological malignancies. Management of such lesions is dictated by anatomy and the behaviour of tumours. Three key issues which arise are the adequacy of tumour resection, mechanical stabilisation and the need for colostomy. Stabilisation is often extensive and can be challenging.Objective
Introduction
To review indications, complications and outcome for revision surgery in metastatic spinal disease. Retrospective review of casenotes and radiographs. 13 patients (9 male, 4 female) identified from a cohort of 222 patients who underwent surgery for spinal tumours between 1994- 2001. Indication for revision, complications, survival. Further recurrence (same or different level). Further surgery, neurological grade and pain score. Of 13 patients (4 Renal, 6 breast, 2 prostate, 1 myeloma) one is alive 101 months following revision. Two have been lost to follow up, 10 have died (mean survival 25.3 months post op). The mean time between primary and revision surgery was 10 months (range 1- 32 months) 4 disease progression (same level), 4 new level disease, 3 loss of fixation, 1 radiological collapse, 1 progressive kyphus. Approaches used: 4 anterior, 8 posterior, 1 posterior + anterior. The mean number of levels which required instrumentation on revision was 5. Modal pain score pre op 5, modal post op 3, minimum one point improvement. Preop modal Frankel grade E, postoperatively all preserved or improved one grade. Modal Karnofsky score preop 70 (30- 90), postop 80 (40-90)- all but one at least 10 point increase. Complications: 1Dural tear, 1 bacteraemia, 1 chylothorax, 1 loss of fixation. 3 patients required further surgery (range 4 months- 18 months, mean 11 months) Patients with metastatic disease may benefit from second procedures for recurrent disease whether locally or distant with excellent survival, low complications and good function.
To evaluate functional and oncological outcomes following resection of primary malignant bone tumours. Primary malignant tumours of the sacrum are rare, arising from bony or neural elements, or bone marrow in haematological malignancies. Management of these lesions is dictated by anatomical considerations and the behaviour of tumours. The three key issues which arise are the adequacy of tumour resection, mechanical stabilisation and the need for colostomy. A retrospective review of the surgical management of primary malignant sacral tumours from 2004 - 2009. The study included 46 patients (34 males, 12 females) with an average age of 49 (range 7 – 82). Median duration of symptoms before presentation was 26 months. 10 patients had inoperable tumours at presentation. 6 patients had chemotherapy. 2 patients opted for palliative radiotherapy. 1 patient was unfit for surgery. 25 patients (54%) underwent surgical resection. 8 underwent instrumented stabilisations with fibula strut graft vs. 17 uninstrumented. Colostomy was performed in 10 patients (40%). Mean follow post-operatively was 19.0 months. Wound healing problems were present in 5/25 (20%). There was no difference in infection rates between definitive surgery with and without colostomy. Mechanical failure of stabilisation was noted in 75%. There was one peri-operative death. Local recurrence occurred in 12%(3/25) of operated patients although follow-up period was noted to be short. Mechanical stabilisation for extensive lesions in the sacrum are particularly challenging in tumour surgery. Despite radiological failure in 7/8 instrumented stabilisations, patients were relatively asymptomatic and only 1/8 required revision stabilisation surgery. Ethics approval: None: Audit Interest Statement: None
Spinal Deformity Service, Royal Orthopaedic Hospital, Birmingham, UK To describe the technique of nonfusion annulotomy and nuclectomy with posterior growing rod instrumentation for the treatment of non-congenital early onset scoliosis To present our results of the application of this technique in a consecutive series of nine patients with mean follow up of 76 months (range 16 to 123 months) We undertook retrospective observational casenote and radiograph study of patients with noncongenital early onset scoliosis having annulotomy and nuclectomy at the apex of their respective curves with standard posterior growing rod instrumentation between 1998 and 2009. 10 patients were identified with one excluded due to short follow up period. Of the nine patients included mean follow up was 76 months. Mean age at primary surgery was 71.7 months (range 29- 97 months) We measured pre and post operative Cobb angle, T1-S1 height change and change in height over the apical segments. Mean pre op cobb angle was 74° (range 62- 81°). Mean post op cobb angle was 38°. Three patients have completed their treatment programme with a mean number of 9 lengthenings achieved. Six patients are still undergoing lengthenings. CT demonstrates that the annulotmized segment does not fuse at a mean 3.5 years postoperatively. All patients demonstrated growth over total spinal height and also over apical segments which had undergone annultomy/ nuclectomy. We also report complications. We have demonstrated that anterior annulotomy and nuclectomy with posterior growing rod construct does allow for spinal growth over released segments without autofusion.
