Document Detail


Scoliosis after extended hemipelvectomy.
MedLine Citation:
PMID:  20975486     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
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.
Authors:
Ioannis Papanastassiou; Patrick J Boland; Oheneba Boachie-Adjei; Carol D Morris; John H Healey
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Spine     Volume:  35     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E1328-33     Citation Subset:  IM    
Affiliation:
Memorial Sloan-Kettering Cancer Center, Affiliated with Weill Medical College of Cornell University, New York, NY 10021, USA.
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