For high sacrectomies, both an anterior and posterior approach are required.
During the initial anterior approach, the goals are:
- Anterior tumor dissection from the rectum and vascular structures
- Consideration of a diversion colostomy
- Vertical Rectus Abdominus Muscle (VRAM) flap harvest
During the posterior approach, the osteotomies are completed, and the tumor is delivered.
A wide visualization is essential in these cases. An adequate amount of sacral lamina needs to be removed to achieve:
- Good visualization of normal and abnormal anatomy
- Safe decompression of the neural elements.
Sacral nerve root sacrifice is associated with neurological morbidity.
If at least one S3 nerve root is preserved, a degree of continence will be maintained in most patients.
For a high sacral resection (as in this case), the bilateral S2 to S5 nerve roots will be sacrificed. Complete loss of bowel, bladder and sexual function can be expected.
A diversion colostomy may be considered to reduce the risk of wound complications.
A multidisciplinary team is needed to perform a sacrectomy. This team should include a spine surgeon, a plastic surgeon, and a general surgeon. A vascular surgeon may also be needed.
This picture shows a large sacrum chordoma.