A novel “pelvic ring augmentation construct” for lumbo-pelvic reconstruction in tumour surgery

摘要: Aim Reconstructing or augmenting the lumbo-pelvic junction after resection of L5 and part sacrum is challenging. Numerous reconstruction methods based on posterior construct anterior cages have been proposed for cases involving total sacrectomy lumbar vertebrectomy. These constructs create long lever arms generate high cantilever forces across lumbo-sacral junction, resulting in implant failure breakage. Biomechanical studies shown that placing implants to pivot point provides a more effective moment arm resist flexion force improves ultimate strength construct. We present here novel method augment construction using pelvic ring Methods A 69-year-old lady presented with her two previous reconstructions performed by authors. She initially presented, half years previously 6 months history back pain normal neurological function. MRI scans whole spine showed isolated secondaries (L4, L5) (S1). An abdominal CT scan revealed primary tumour right kidney. Briefly, first surgery involved single-stage removal elements L4 stabilisation from L2 pelvis, partially S1 implantation an expandable Synex II cage. The cage was replaced rod L3 trans-sacral screw week later as it had dislodged. second revision, 9 later, broken rods which were converted into modified four-rod While monitoring progress, subsequently noted broken. Therefore, decided prevent eventual catastrophic failure. From approach, contoured passed bilaterally along inner table pelvis under iliacus muscle up border pelvis. Using T-connectors, connected Thereafter, supra-acetabular screws subcutaneously placed matched shape wall. completed connecting this T-connectors free ends iliac rods. Results conclusion There no intra-operative complications. At end 12 months, she mobilising frame, radiological evidence However, died due disease progression at 15 months. Experience one clinical case shows such feasible adds technical option difficult surgery.