| Scoliosis after extended hemipelvectomy. | |
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MedLine Citation:
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PMID: 20975486 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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STUDY DESIGN: Retrospective review plus 2 representative case reports. OBJECTIVE: To evaluate the prevalence of scoliosis after extended hemipelvectomy (EH) and illustrate the problem's severity. SUMMARY OF BACKGROUND DATA: No published series has analyzed this problem. Data are needed to decide the potential need for and timing of spine fusion in these patients. METHODS: We treated 14 patients with EH over 10 years. Mean age was 47 years. Diagnoses included osteosarcoma (6); chondrosarcoma (4); metastatic cancer (2); and MFH and undifferentiated sarcoma (1 each). Operating time ranged from 7 to 15 hours, and mean estimated blood loss was 8 L. Patients were observed for scoliosis, functional results, and for oncological outcome (survival, disease progression). Two patients who became scoliotic after EH illustrate the problem: a 31-year-old man underwent EH for pelvic osteosarcoma and progressively developed a painful 44° scoliotic curve; and a 27-year-old woman who developed a 60° painful scoliotic curve and radiculopathy years after EH including L5-S1 disc disruption. RESULTS: Of 12 patients, 8 died within 7 months of EH. Only 2 of 12 patients are long-term survivors free of disease (3 and 6 years after surgery), and 2 are alive with disease more than 1 year after surgery. In patients >1 year survival, 3 of 4 patients had curves greater than 20°. Of 10 evaluable patients, 2 developed a curve greater than 30° that warranted fusion. Four others had curves between 20° and 30°. Of these 6, 5 developed a sharp-angled lumbar curve with the concavity away from the operated side. Risk factors for symptomatic scoliosis after EH include disc disruption, paraspinal muscle/ligament resection, or facetectomies in ambulatory patients with a lengthy survival. CONCLUSION: Primary spinal fixation should be avoided because of the high morbidity and early mortality of EH. Selected high-risk patients can be stabilized later if they develop painful instability. |
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Authors:
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Ioannis Papanastassiou; Patrick J Boland; Oheneba Boachie-Adjei; Carol D Morris; John H Healey |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Spine Volume: 35 ISSN: 1528-1159 ISO Abbreviation: Spine Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-26 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7610646 Medline TA: Spine (Phila Pa 1976) Country: United States |
Other Details:
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Languages: eng Pagination: E1328-33 Citation Subset: IM |
Affiliation:
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Memorial Sloan-Kettering Cancer Center, Affiliated with Weill Medical College of Cornell University, New York, NY 10021, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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