Lumbosacral resection and reconstruction

Sacrectomies (either partial or total) are indicated for a primary malignancy or recurrent pelvic tumors that require a resection for cure. For these patients an en bloc resection is indicated, potentially compromising spinopelvic continuity. The extent of resection varies based on the location and type of tumor, and most types of partial sacrectomy do not require reconstruction. Since oncologic outcome is favorable when an en bloc resection can be obtained with negative margins, frequently the reconstructive procedures are hindered with large bony and posterior soft-tissue defects. This combined with the complex anatomy of the pelvis, vascular, and visceral structures make surgery and reconstruction technically complex. The purpose of this chapter is to describe the indications and also techniques for sacral reconstruction.