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Percutaneous lumbopelvic fixation for pathologic sacral fractures and spinopelvic dissociation: patient series

BACKGROUND: Because patients with advanced cancer live longer, the number of patients with the sequelae of metastatic spine disease has increased. Pathologic instability of the mobile spine has been classified, and minimally invasive surgery has been well described. However, pathologic sacral instab...

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Autores principales: Baksh, Nikolas, Yeung, Caleb, Vaynrub, Max
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Association of Neurological Surgeons 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10555589/
https://www.ncbi.nlm.nih.gov/pubmed/37581594
http://dx.doi.org/10.3171/CASE23205
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author Baksh, Nikolas
Yeung, Caleb
Vaynrub, Max
author_facet Baksh, Nikolas
Yeung, Caleb
Vaynrub, Max
author_sort Baksh, Nikolas
collection PubMed
description BACKGROUND: Because patients with advanced cancer live longer, the number of patients with the sequelae of metastatic spine disease has increased. Pathologic instability of the mobile spine has been classified, and minimally invasive surgery has been well described. However, pathologic sacral instability is uncommon and often underdiagnosed. Although most sacral fractures are stable, patients with unstable U- or H-type fractures have spinopelvic dissociation and can experience progressive pain, sacral kyphosis, and neurological injury. Open lumbopelvic fusion carries a high perioperative risk for this patient population, which has often been previously radiated and is medically frail. The authors investigated the utility and safety of percutaneous lumbopelvic fixation, as previously described for traumatic spinopelvic dissociation, in the oncological setting. The authors retrospectively reviewed five consecutive patients with unstable pathologic sacral fractures who had undergone percutaneous lumbopelvic fixation after conservative management failed. OBSERVATIONS: Patients experienced significant improvement between pre- and postoperative visual analog scale scores (9.2 and 1.6, respectively) and Eastern Cooperative Oncology Group grades (median 3 and 1, respectively). All patients were independently ambulatory at the final follow-up. Sagittal alignment remained stable in four patients and worsened in one. There were no major medical or surgical complications. LESSONS: Percutaneous lumbopelvic fixation shows promising results for palliation, durability, and safety for pathologic sacropelvic instability.
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spelling pubmed-105555892023-10-07 Percutaneous lumbopelvic fixation for pathologic sacral fractures and spinopelvic dissociation: patient series Baksh, Nikolas Yeung, Caleb Vaynrub, Max J Neurosurg Case Lessons Case Lesson BACKGROUND: Because patients with advanced cancer live longer, the number of patients with the sequelae of metastatic spine disease has increased. Pathologic instability of the mobile spine has been classified, and minimally invasive surgery has been well described. However, pathologic sacral instability is uncommon and often underdiagnosed. Although most sacral fractures are stable, patients with unstable U- or H-type fractures have spinopelvic dissociation and can experience progressive pain, sacral kyphosis, and neurological injury. Open lumbopelvic fusion carries a high perioperative risk for this patient population, which has often been previously radiated and is medically frail. The authors investigated the utility and safety of percutaneous lumbopelvic fixation, as previously described for traumatic spinopelvic dissociation, in the oncological setting. The authors retrospectively reviewed five consecutive patients with unstable pathologic sacral fractures who had undergone percutaneous lumbopelvic fixation after conservative management failed. OBSERVATIONS: Patients experienced significant improvement between pre- and postoperative visual analog scale scores (9.2 and 1.6, respectively) and Eastern Cooperative Oncology Group grades (median 3 and 1, respectively). All patients were independently ambulatory at the final follow-up. Sagittal alignment remained stable in four patients and worsened in one. There were no major medical or surgical complications. LESSONS: Percutaneous lumbopelvic fixation shows promising results for palliation, durability, and safety for pathologic sacropelvic instability. American Association of Neurological Surgeons 2023-08-07 /pmc/articles/PMC10555589/ /pubmed/37581594 http://dx.doi.org/10.3171/CASE23205 Text en © 2023 The authors https://creativecommons.org/licenses/by-nc-nd/4.0/CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Case Lesson
Baksh, Nikolas
Yeung, Caleb
Vaynrub, Max
Percutaneous lumbopelvic fixation for pathologic sacral fractures and spinopelvic dissociation: patient series
title Percutaneous lumbopelvic fixation for pathologic sacral fractures and spinopelvic dissociation: patient series
title_full Percutaneous lumbopelvic fixation for pathologic sacral fractures and spinopelvic dissociation: patient series
title_fullStr Percutaneous lumbopelvic fixation for pathologic sacral fractures and spinopelvic dissociation: patient series
title_full_unstemmed Percutaneous lumbopelvic fixation for pathologic sacral fractures and spinopelvic dissociation: patient series
title_short Percutaneous lumbopelvic fixation for pathologic sacral fractures and spinopelvic dissociation: patient series
title_sort percutaneous lumbopelvic fixation for pathologic sacral fractures and spinopelvic dissociation: patient series
topic Case Lesson
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10555589/
https://www.ncbi.nlm.nih.gov/pubmed/37581594
http://dx.doi.org/10.3171/CASE23205
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