Keywords:
Musculoskeletal system, Musculoskeletal spine, Pelvis, MR, CT
Authors:
M. Thomas, A. M. Davies, A. J. Stirling, R. J. Grimer, M. Grainger, S. L. James; Birmingham/UK
DOI:
10.1594/ecr2012/C-0234
Conclusion
This procedure carries a high rate of complications including postoperative infection,
metalwork and graft failure and disease recurrence.
Sacral surgery carries a particularly high rate of infection,
attributed to the number of surgeons carrying out each operation,
the large surgical exposure and long duration of surgery as well as the proximity to bowel.
(3) Rod fracture has only been described in two cases in the literature,
although considerably more common in our series.
(4,
5)
Non-union of strut graft/ bone interface was also common occurrence in our patient group.
Relatively few cases of non union were reported in the surgical literature: 4 patients with total sacrectomy and instrumentation in a study by Randall and coworkers,
a single case in a series of 9 sacrectomy patients by Dickey and coworkers,
and the case reported by Spiegel and co-workers.
In two of these cases,
the areas were augmented with bone graft to encourage bony fusion.
(6-8)
Although graft fractures were observed in 2 patients in this series,
no other cases of graft fracture are documented in the literature.
Our patients demonstrated particularly poor bone union of strut grafts: it seems likely that the fractures seen in this study reflected a change in loading from failure of the rest of the construct.
Cases series in the literature show a relatively high rate of recurrence of chordoma within the spine and sacrum,
reaching up to 44% recurrence in a study of 39 patients by Bergh and co-workers.
(9) Recurrence after en bloc resection of spinal and sacral chondrosarcoma is quoted at 20%.
(10) No reliable data regarding recurrence rates after resection of sacral osteosarcoma is available owing to the rarity of the condition.
Bursa formation over protruding instrumentation,
particularly after structural collapse,
can potentially cause diagnostic confusion with infected collection or local recurrence.
Unusual consequences of instrumentation failure may also be seen,
such as the small bowel perforation from a displaced strut graft described here.