Sacrectomy: Indications, Surgical Techniques, and Complications

Introduction

Sacrectomy is a complex surgical procedure involving the partial or complete removal of the sacrum, the triangular bone located at the base of the spinal cord between the two hip bones. It is a highly specialized and effective procedure typically performed for persons with tumors, severe trauma, congenital abnormalities, or extensive infections affecting the sacrum. This article aims to provide an overview of sacrectomy, including its indications, surgical techniques, potential complications, and postoperative considerations.

What Are the Indications for Sacrectomy?

Sacrectomy is considered when other treatment options have been exhausted, and the sacrum's condition poses significant risks to the patient's health and quality of life. The most common indications for sacrectomy include:

• Sacral Tumors: Sacral tumors, such as chordomas or metastatic lesions, may require sacrectomy if they are extensive or have invaded nearby structures. Sacrectomy is used both in benign and malignant sacral tumors. Malignant sacral tumors include malignant peripheral nerve sheath tumors, osteosarcoma, chordoma, and chondrosarcoma. Sacral tumors may arise from various parts of the sacrum, like nerve sheath, soft tissue, or bone.

• Severe Trauma: In cases of severe fractures or traumatic injuries involving the sacrum, a sacrectomy may be necessary to manage instability or prevent further complications.

• Infections: Extensive or severe infections affecting the sacrum, such as osteomyelitis or necrotizing fasciitis, may necessitate partial or complete sacrectomy to control the infection and promote healing.

• Congenital Abnormalities: Some rare congenital abnormalities like massive sacral teratomas and certain abnormalities associated with sacral agenesis require Sacrectomy for effective treatment.

What Are the Symptoms of Sacral Tumors?

The symptoms of sacral tumors are similar to the sciatica. Other symptoms may include tailbone pain, sexual dysfunction, thinning stool, altered perineal sensation, and urinary retention or incontinence.

What Are the Surgical Techniques for Sacrectomy?

Sacrectomy is a complex and challenging procedure that requires a multidisciplinary team involving orthopedic surgeons, neurosurgeons, and reconstructive surgeons. The surgical technique employed depends on the extent of sacral involvement and the patient's overall condition. There are three main types of sacrectomy:

• Partial Sacrectomy: An affected portion of the sacrum is removed while preserving the pelvic ring and functional stability. The remaining sacrum is stabilized using various internal fixation devices, such as plates and screws. Partial sacrectomy may minimize the complications of complete or total sacrectomy.

• Hemisacrectomy: Hemisacrectomy involves the removal of half of the sacrum, along with the corresponding affected vertebral bodies. The pelvic ring is reconstructed using prosthetic implants or autografts.

• Total Sacrectomy: Total sacrectomy is the most extensive form of sacral resection, involving the complete removal of the sacrum and often adjacent structures, such as the lower lumbar spine or pelvic organs. Complex reconstructive techniques are required to restore pelvic stability and preserve bowel and bladder function. Some reconstructive methods include bone grafts, spinal instrumentation, and pelvic fixation.

What Are the Potential Complications of Sacrectomy?

Sacrectomy is a major surgical procedure associated with potential complications, including:

• Infection: Wound infections or deep-seated infections may occur following sacrectomy and require appropriate antibiotic treatment. Strict sterile techniques and postoperative follow-up are essential to reduce the risk of infections.

• Neurological Deficits: Nerve damage is a significant concern during sacrectomy, leading to sensory and motor deficits that include lower extremities weakness, bowel or bladder dysfunction, and sexual dysfunction. It is the responsibility of the surgeons to assess the nerve function preoperatively and perform the surgery accurately without damaging the adjacent nerves.

• Nonunion or Malunion: Improper healing or alignment of the remaining sacrum or pelvic ring may result in nonunion or malunion, leading to persistent pain, instability, or gait abnormalities.

• Delayed Wound Healing: Wound healing problems can occur due to the complexity of the surgical site. Some of the wound healing issues are wound dehiscence and delayed wound healing. Close follow-up, monitoring, and wound care may help to manage such complications.

• Altered Bowel and Bladder Function: Total sacrectomy can disrupt normal bowel and bladder function, requiring surgical interventions or the use of assistive devices.

• Pelvic Instability: Sacrectomy may lead to pelvic instability that may cause difficulty in walking, sitting, and performing daily activities. Surgical stabilization techniques may be employed to treat the issue.

What Are the Postoperative Considerations for Sacrectomy?

After sacrectomy, the patient undergoes an extensive rehabilitation process involving physical therapy and occupational therapy. The duration and intensity of rehabilitation vary depending on the extent of the surgery and the patient's overall condition. Specific postoperative considerations include

• Pain Management: Appropriate pain control is essential to ensure patient comfort during recovery time. Multiple approaches like physical therapy and medications may be employed.

• Long-Term Functional Implications: This sacrectomy procedure may cause long-term functional impairments that include alteration of gait, continence, and balance. Some assistive devices like orthotics and mobility aids may help people to address their functional limitations.

• Psychological Support: Sacrectomy is a life-changing procedure that can have a significant emotional and psychological impact on affected patients. Getting appropriate psychological support and counseling throughout the treatment procedures may be beneficial for the affected patients.

• Mobility and Rehabilitation: Rehabilitation plays an important role in the postoperative consideration of sacrectomy. Physical therapy and specific exercises may help to regain mobility, strength, and independence.

Conclusion

Sacrectomy is a complex procedure done to repair the sacrum, especially used in cases where other treatment options are inadequate. It involved a small part, half or complete sacrum. Sacrectomy procedure offers potential benefits for patients that majority helps in retaining the quality of life of the patients. It involves a group of healthcare professionals. Reaching out to specialized healthcare professionals may be beneficial.