Scoliosis after extended hemipelvectomy Journal Article
| Authors: | Papanastassiou, I.; Boland, P. J.; Boachie-Adjei, O.; Morris, C. D.; Healey, J. H. |
| Article Title: | Scoliosis after extended hemipelvectomy |
| Abstract: | 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. © 2010 Lippincott Williams & Wilkins. |
| Keywords: | osteosarcoma; adult; cancer survival; clinical article; treatment outcome; aged; middle aged; retrospective studies; disease course; disease free survival; pelvis; metastasis; bleeding; prevalence; medical record review; risk factor; sarcoma; disease severity; disease progression; spine; operation duration; ambulatory care; surgical mortality; malignant fibrous histiocytoma; chondrosarcoma; functional status; fusion; scoliosis; extended hemipelvectomy; hemipelvectomy; intervertebral disk disease; lumbar disk; muscle resection; radiculopathy; spine disease; spine fusion |
| Journal Title: | Spine |
| Volume: | 35 |
| Issue: | 23 |
| ISSN: | 0362-2436 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2010-11-01 |
| Start Page: | E1328 |
| End Page: | E1333 |
| Language: | English |
| DOI: | 10.1097/BRS.0b013e3181e39183 |
| PUBMED: | 20975486 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Export Date: 20 April 2011" - "CODEN: SPIND" - "Source: Scopus" |
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