JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Bilateral iliac screws were placed, three in each iliac crest. Vertical rods were run from L3 to L5 and extended to attach to the last pair of iliac screws. Two horizontal rods were used to connect the top two pairs of iliac screws with a fibula strut wired between the rods (Figures 4 and 5). The posterior incision was closed using bilateral advancement
interventional radiology was positive for chordoma. The patient elected for surgery and underwent resection of the mass with a combined surgical oncology and neurosurgery approach carried out over two days. The surgical oncologist started the resection with an abdominal laparotomy and dissection of the pelvis to free the pelvic viscera, iliac vessels, and ureters off the lateral pelvic walls and sacrum. Once these structures were mobilized, the abdomen was closed and the patient flipped into the prone position. The neurosurgeon then opened a midline lumbosacral incision and placed pedicle screws along L3 to L5. The dissection exposed the sacral mass as well as the sacroiliac joints. The thecal sac and nerve roots were tied off at the level of S1 with sacrifice of the right S1 nerve root. An osteotome was then used to cut through the S1 vertebral body and the SI joints and the tumor was removed en bloc (Figures 2 and 3).
Figure 4: Posterior lumbo-iliac fixation. The lumbar pedicle screws were connected to the most inferior pair of iliac screws with vertical rods. The superior two pairs of iliac screws were connected with horizontal rods with a fibular strut wired between the rods for additional pelvic stabilization.
Figure 2: Posterior viewof the pelvis after removal of sacral chordoma and ligation of thecal sac and nerve roots. The abdominal packing placed during the anterior part of the procedure is visible.
Figure 5: Postoperative xray demonstrating instrumentation from L3 to iliac crests.Vertical rods runalongL3 toL5andattachtothebottom- most pair of iliac screws. Horizontal rods connect the remaining two pairs of iliac screws with a fibular strut placed horizontally and wired to the two rods.
Figure 3: Gross pathology specimen resected en bloc.
J La State Med Soc VOL 170 MAY/JUNE 2018 73
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