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A New Surgical Technique (Modified Osaka Technique) of Sacral Resection by Posterior Approach Only: Description and Preliminary Results.
MedLine Citation:
PMID:  23169067     Owner:  NLM     Status:  Publisher    
ABSTRACT: Study Design. Operative techniqueObjective. To present a new technique for sacral resection, with short term preliminary results.Summary of Background Data. Although various reports analyzed "en-bloc" excision of sacral tumors, there are still technical problems to improve protection of nerve roots, preserve surrounding structures and reduce intraoperative bleeding, maintaining the oncologic result.Methods. Thirteen patients were resected for their sacrococcygeal tumor with the followed described technique. Two patients had previous surgery elsewhere. The sacrum was exposed by a posterior midline incision and complete soft-tissue dissection. Lateral osteotomies were performed through the sacral foramina using a threadwire saw (devised by Tomita and Kawahara and subsequently modified by Osaka et al.) and Kerrison rongeurs, to avoid sacral roots damage. After proximal osteotomy, the sacrum was laterally elevated and mobilized to allow dissection of presacral structures. Mean surgical time was 5.5 hours (range; 1.5 to 8). Mean blood loss was 2961 ml (range; 1000 to 8000 ml).Results. Level of resection was proximal in nine patients and at S3 or below in four. Margins were wide in ten patients, marginal in one and intralesional in two. At a mean follow-up of 35.5 months, nine patients were disease-free, while the tumor recurred locally in four cases. Complications requiring surgery were seen in one case.Conclusion. The presented technique allows wide margins with roots preservation and reduction in blood loss and operative time. Indications for posterior approach only can be extended to resection proximal to S3, when there is minimal pelvic invasion and none or partial involvement of sacroiliac joints. However, the long term benefits of this technique need to be evaluated.
Andrea Angelini; Pietro Ruggieri
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-19
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Bologna, Italy.
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