J Korean Soc Spine Surg.  2016 Jun;23(2):114-120. 10.4184/jkss.2016.23.2.114.

Spinopelvic Reconstruction with Femoral Allograft and Vertical Rectus Abdominis Myocutaneous Flap after Total Sacrectomy in Recurrent Sacral Chordoma: A Case Report

• Park SM
• Jung JH
• Lee CK
• Kim H
• Chang BS

• KMID: 2328005
• DOI: http://doi.org/10.4184/jkss.2016.23.2.114

Abstract

STUDY DESIGN: Case report.
OBJECTIVES
To report a case of recurrent sacral chordoma treated with total sacrectomy and spinopelvic reconstruction. SUMMARY OF LITERATURE REVIEW: Sacral chordoma is a musculoskeletal tumor reported to have a low incidence. Surgical treatment is considered difficult due to the complicated sacropelvic structure, so the prognosis for patients with sacral chordoma has been considered poor.
MATERIALS AND METHODS
We report a surgical technique and outcomes from spinopelvic reconstruction with femoral allograft and vertical rectus abdominis myocutaneous flap after total sacrectomy.
RESULTS
We report no tumor recurrence at 43 months postoperatively.
CONCLUSIONS
Spinopelvic reconstruction with thorough surgical planning after total sacrectomy was found to be a safe and effective treatment method.

Keyword

Sacral chordoma; Spinopelvic reconstruction; Vertical rectus abdominis myocutaneous flap

MeSH Terms

Allografts*
Chordoma*
Humans
Incidence
Methods
Myocutaneous Flap*
Prognosis
Rectus Abdominis*
Recurrence

Figure

• 

  Fig. 1. Pelvic anteroposterior (A) and lateral radiographs (B) show a soft tissue mass in the presacral area with sacral destruction. The axial CT (C) and PET/CT (D) images show a destructive soft tissue mass with the rectum and bladder compressed at the S2 level. Gadolinium-enhanced fat-suppressed T1-weighted axial (E) and sagittal (F) MR images also show a large lobulating soft tissue mass destructing the sacrum.

• 

  Fig. 2. (A) An intraoperative photo shows harvesting of the vertical rectus abdominis myocutaneous flap. (B) An intraabdominal photo shows the ligated internal iliac artery (arrow). (C) A posterior incision bypassed the scar of the previous operation to eliminate the tumor. (D) The resected tumor mass with contaminated skin after total sacrectomy. (E) A femoral bone allograft between the iliac bone and L5 was fixed by a half-threaded cortical screw and pedicle, while an iliac screw and rod system was fixed for stabilization from L3 to the iliac bone. (F, G) Soft tissue reconstruction with a vertical rectus abdominis myocutaneous flap from the intraabdominal space was performed by a plastic surgeon. The pelvis anteroposterior (H) and lateral (I) radiographs show a total sacrectomy with spinopelvic reconstruction with a femoral allobone graft.

• 

  Fig. 3. The pelvis anteroposterior (A) and lateral (B) radiographs show loosening of the iliac screw (arrow) and rod breakage (arrowhead) at 31 months postoperatively. Axial (C) and sagittal (D) CT images show nonunion between the femoral allograft and both ilia (arrow).

• 

  Fig. 4. After the second operation, the pelvics anteroposterior (A) and lateral (B) radiographs show the new iliac screw and rod with a fresh frozen allobone chip graft at the previous graft-ilium junction.

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  Fig. 5. The pelvis anteroposterior (A) and lateral (B) radiographs show well-maintained fixation and graft material.

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