TY - JOUR
T1 - Soft Tissue and Bone Defect Management in Total Sacrectomy for Primary Sacral Tumors
T2 - A Systematic Review with Expert Recommendations
AU - Reynolds, Jeremy
AU - Khundkar, Roba
AU - Boriani, Stefano
AU - Williams, Richard
AU - Rhines, Laurence D.
AU - Kawahara, Norio
AU - Wolinsky, Jean Paul
AU - Gokaslan, Ziya L.
AU - Varga, Peter
PY - 2016/8/8
Y1 - 2016/8/8
N2 - 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
AB - 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
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U2 - 10.1097/BRS.0000000000001834
DO - 10.1097/BRS.0000000000001834
M3 - Article
AN - SCOPUS:84981164465
JO - Spine
JF - Spine
SN - 0362-2436
ER -