{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T11:12:46Z","timestamp":1793445166688,"version":"4.5.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:00:00Z","timestamp":1616630400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:00:00Z","timestamp":1616630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["International Orthopaedics (SICOT)"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>To investigate the indications, approaches, resection methods, and complications of total sacrectomy with a combined antero-posterior approach for malignant sacral tumours.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Fourteen cases of primary malignant sacral tumours treated with total sacrectomy between January 2012 and 2018 were retrospectively analysed. All patients presented with pre-operative lumbosacral pain or constipation. A combined antero-posterior approach was used for tumour resection, and the spinal pedicle screw rod system was used to achieve ilio-lumbar stability. The visual analogue scale (VAS) and Musculoskeletal Tumor Society (MSTS) scores were used to assess pain and lower limb function, respectively. The mean operative time and intra-operative blood loss were 6.54 hours and 2935 mL, respectively. The mean follow-up period was 62 months.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>None of the patients died peri-operatively. At the last follow-up, ten patients were continuously disease-free, three were alive with disease, and one died of disease from lung metastasis. Tumour recurrence occurred in three patients. The MSTS scores ranged from 6 to 28 (20.00\u201393.33%, 6\/30\u201328\/30) with an average of 20 (66.67%, 20\/30). Seven patients could walk independently in public, five could only walk at home using a walking aid, and two could only lie down and stand for a short time. Thirteen patients developed post-operative complications such as skin necrosis, screw loosening, connecting rod fracture, neuropathic pain, sciatic nerve injury, dysuria, and urinary incontinence.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Total sacrectomy can effectively treat malignant sacral tumours with good resection boundaries and prognosis. However, the high incidence of post-operative complications may impact post-operative neurological function.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00264-021-05006-4","type":"journal-article","created":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T00:05:30Z","timestamp":1616717130000},"page":"1347-1354","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Total sacrectomy with a combined antero-posterior surgical approach for malignant sacral tumours"],"prefix":"10.1007","volume":"45","author":[{"given":"Feifei","family":"Pu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhicai","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baichuan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianxiang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4138-0711","authenticated-orcid":false,"given":"Zengwu","family":"Shao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,25]]},"reference":[{"issue":"9","key":"5006_CR1","doi-asserted-by":"publisher","first-page":"1841","DOI":"10.1007\/s00264-020-04641-7","volume":"44","author":"J Wang","year":"2020","unstructured":"Wang J, Li D, Yang R et al (2020) Outcome of surgical treatment of children and adolescents with primary malignant sacral tumours. Int Orthop 44(9):1841\u20131851","journal-title":"Int Orthop"},{"issue":"6","key":"5006_CR2","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1179\/1743132814Y.0000000366","volume":"36","author":"PP Varga","year":"2014","unstructured":"Varga PP, Sz\u00f6v\u00e9rfi Z, Lazary A (2014) Surgical treatment of primary malignant tumors of the sacrum. Neurol Res 36(6):577\u2013587","journal-title":"Neurol Res"},{"issue":"8","key":"5006_CR3","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1002\/jso.24081","volume":"112","author":"VY Ng","year":"2015","unstructured":"Ng VY, Jones R, Bompadre V et al (2015) The effect of surgery with radiation on pelvic Ewing sarcoma survival. J Surg Oncol 112(8):861\u2013865","journal-title":"J Surg Oncol"},{"issue":"16","key":"5006_CR4","doi-asserted-by":"publisher","first-page":"1207","DOI":"10.1097\/BRS.0000000000002043","volume":"42","author":"Y Wang","year":"2017","unstructured":"Wang Y, Guo W, Shen D et al (2017) Surgical treatment of primary osteosarcoma of the sacrum: a case series of 26 patients. Spine (Phila Pa 1976) 42(16):1207\u20131213","journal-title":"Spine (Phila Pa 1976)"},{"issue":"2","key":"5006_CR5","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1007\/s00586-013-3075-z","volume":"23","author":"SS Bederman","year":"2014","unstructured":"Bederman SS, Shah KN, Hassan JM et al (2014) Surgical techniques for spinopelvic reconstruction following total sacrectomy: a systematic review. Eur Spine J 23(2):305\u2013319","journal-title":"Eur Spine J"},{"issue":"1","key":"5006_CR6","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1111\/os.12582","volume":"12","author":"ZR Lv","year":"2020","unstructured":"Lv ZR, Li ZF, Yang ZP et al (2020) One-step reconstruction with a novel suspended, modular, and 3D-printed total sacral implant resection of sacral giant cell tumor with preservation of bilateral S(1-3) nerve roots via a posterior-only approach. Orthop Surg 12(1):58\u201366","journal-title":"Orthop Surg"},{"issue":"Suppl 20","key":"5006_CR7","doi-asserted-by":"publisher","first-page":"S199","DOI":"10.1097\/BRS.0000000000001834","volume":"41","author":"JJ Reynolds","year":"2016","unstructured":"Reynolds JJ, Khundkar R, Boriani S et al (2016) Soft tissue and bone defect management in total sacrectomy for primary sacral tumors: a systematic review with expert recommendations. Spine (Phila Pa 1976) 41(Suppl 20):S199\u2013S204","journal-title":"Spine (Phila Pa 1976)"},{"issue":"2","key":"5006_CR8","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/j.bjps.2019.09.049","volume":"73","author":"M Asaad","year":"2020","unstructured":"Asaad M, Rajesh A, Wahood W et al (2020) Flap reconstruction for sacrectomy defects: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 73(2):255\u2013268","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"3","key":"5006_CR9","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1007\/s11999-016-4729-z","volume":"475","author":"P Kiatisevi","year":"2017","unstructured":"Kiatisevi P, Piyaskulkaew C, Kunakornsawat S et al (2017) What are the functional outcomes after total sacrectomy without spinopelvic reconstruction? Clin Orthop Relat Res 475(3):643\u2013655","journal-title":"Clin Orthop Relat Res"},{"issue":"8","key":"5006_CR10","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.1002\/jso.25756","volume":"120","author":"Y Wang","year":"2019","unstructured":"Wang Y, Liang W, Qu S et al (2019) Assessment of patient experiences following total sacrectomy for primary malignant sacral tumors: a qualitative study. J Surg Oncol 120(8):1497\u20131504","journal-title":"J Surg Oncol"},{"issue":"1","key":"5006_CR11","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1007\/s10143-019-01194-1","volume":"43","author":"J Goldberg","year":"2020","unstructured":"Goldberg J, Bayerl SH, Witzel C et al (2020) Surgical workflow for fully navigated high sacral amputation in sacral chordoma. Neurosurg Rev 43(1):343\u2013349","journal-title":"Neurosurg Rev"},{"issue":"3","key":"5006_CR12","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1007\/s11999-016-4773-8","volume":"475","author":"T Ji","year":"2017","unstructured":"Ji T, Guo W, Yang R et al (2017) What are the conditional survival and functional outcomes after surgical treatment of 115 patients with sacral chordoma? Clin Orthop Relat Res 475(3):620\u2013630","journal-title":"Clin Orthop Relat Res"},{"issue":"1","key":"5006_CR13","doi-asserted-by":"publisher","first-page":"59","DOI":"10.3349\/ymj.2021.62.1.59","volume":"62","author":"KR Kim","year":"2021","unstructured":"Kim KR, Kim KH, Park JY et al (2021) Surgical strategy for sacral tumor resection. Yonsei Med J 62(1):59\u201367","journal-title":"Yonsei Med J"},{"issue":"12","key":"5006_CR14","doi-asserted-by":"publisher","first-page":"2433","DOI":"10.1007\/s00701-019-04072-3","volume":"161","author":"X Gao","year":"2019","unstructured":"Gao X, Jia Q, Cai X et al (2019) Recurrence or neurological loss? Resection mode selection for patients with large sacral chordoma: an analysis of prognostic factors and quality of life. Acta Neurochir 161(12):2433\u20132441","journal-title":"Acta Neurochir"},{"issue":"5","key":"5006_CR15","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1016\/j.spinee.2018.11.002","volume":"19","author":"ODR van Wulfften Palthe","year":"2019","unstructured":"van Wulfften Palthe ODR, Tromp I, Ferreira A et al (2019) Sacral chordoma: a clinical review of 101 cases with 30-year experience in a single institution. Spine J 19(5):869\u2013879","journal-title":"Spine J"},{"issue":"4","key":"5006_CR16","doi-asserted-by":"publisher","first-page":"E173","DOI":"10.1093\/ons\/opy377","volume":"17","author":"ON Kashlan","year":"2019","unstructured":"Kashlan ON, Monson DK, Refai D (2019) The use of anterior lumbosacral interbody fusion in spinopelvic stabilization after high partial sacrectomy. Oper Neurosurg (Hagerstown) 17(4):E173\u2013E176","journal-title":"Oper Neurosurg (Hagerstown)"},{"issue":"6","key":"5006_CR17","doi-asserted-by":"publisher","first-page":"563","DOI":"10.3171\/2015.1.SPINE14237","volume":"22","author":"J Zang","year":"2015","unstructured":"Zang J, Guo W, Yang R et al (2015) Is total en bloc sacrectomy using a posterior-only approach feasible and safe for patients with malignant sacral tumors? J Neurosurg Spine 22(6):563\u2013570","journal-title":"J Neurosurg Spine"},{"issue":"Suppl 3","key":"5006_CR18","first-page":"E472","volume":"3","author":"M Bydon","year":"2015","unstructured":"Bydon M, De la Garza-Ramos R, Bettegowda C et al (2015) En bloc resection of a giant cell tumor in the sacrum via a posterior-only approach without nerve root sacrifice: technical case report. Neurosurg 3(Suppl 3):E472\u2013E478","journal-title":"Neurosurg"},{"issue":"6","key":"5006_CR19","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1302\/0301-620X.100B6.BJJ-2017-1212.R1","volume":"100-B","author":"Y Zhang","year":"2018","unstructured":"Zhang Y, Guo W, Tang X et al (2018) En bloc resection of pelvic sarcomas with sacral invasion: a classification of surgical approaches and outcomes. Bone Joint J 100-B(6):798\u2013805","journal-title":"Bone Joint J"},{"key":"5006_CR20","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1016\/j.wneu.2018.05.212","volume":"116","author":"M Stephens","year":"2013","unstructured":"Stephens M, Gunasekaran A, Elswick C et al (2013) Neurosurgical management of sacral tumors: review of the literature and operative nuances. World Neurosurg 116:362\u2013369","journal-title":"World Neurosurg"},{"issue":"9","key":"5006_CR21","doi-asserted-by":"publisher","first-page":"1963","DOI":"10.1007\/s00586-014-3351-6","volume":"23","author":"G Zheng","year":"2014","unstructured":"Zheng G, Xiao S, Zhang Y et al (2014) A case study using total en bloc sacrectomy and neuroanastomosis for sacral tumor. Eur Spine J 23(9):1963\u20131967","journal-title":"Eur Spine J"},{"issue":"4","key":"5006_CR22","doi-asserted-by":"publisher","first-page":"651","DOI":"10.5603\/FM.a2019.0040","volume":"78","author":"E Nastoulis","year":"2019","unstructured":"Nastoulis E, Karakasi MV, Pavlidis P et al (2019) Anatomy and clinical significance of sacral variations: a systematic review. Folia Morphol (Warsz) 78(4):651\u2013667","journal-title":"Folia Morphol (Warsz)"},{"key":"5006_CR23","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.suronc.2019.11.003","volume":"32","author":"N Ratto","year":"2020","unstructured":"Ratto N, Boffano M, Pellegrino P et al (2020) The intraoperative use of aortic balloon occlusion technique for sacral and pelvic tumor resections: a case-control study. Surg Oncol 32:69\u201374","journal-title":"Surg Oncol"},{"issue":"3","key":"5006_CR24","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1007\/s11999-016-4858-4","volume":"475","author":"AK Freeman","year":"2017","unstructured":"Freeman AK, Thorne CJ, Gaston CL et al (2017) Hypotensive epidural anesthesia reduces blood loss in pelvic and sacral bone tumor resections. Clin Orthop Relat Res 475(3):634\u2013640","journal-title":"Clin Orthop Relat Res"},{"issue":"2","key":"5006_CR25","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1111\/os.12336","volume":"9","author":"SH He","year":"2017","unstructured":"He SH, Xu W, Sun ZW et al (2017) Selective arterial embolization for the treatment of sacral and pelvic giant cell tumor: a systematic review. Orthop Surg 9(2):139\u2013144","journal-title":"Orthop Surg"},{"key":"5006_CR26","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.clinbiomech.2019.10.019","volume":"70","author":"S Huang","year":"2019","unstructured":"Huang S, Ji T, Guo W (2019) Biomechanical comparison of a 3D-printed sacrum prosthesis versus rod-screw systems for reconstruction after total sacrectomy: a finite element analysis. Clin Biomech (Bristol, Avon) 70:203\u2013208","journal-title":"Clin Biomech (Bristol, Avon)"},{"issue":"2","key":"5006_CR27","first-page":"393","volume":"58","author":"OI David","year":"2017","unstructured":"David OI, Lupa\u015fcu-Ursulescu CV, Lupa\u015fcu CD et al (2017) Histopathological diagnosis and its correlations with anatomoclinical features, surgical approach and postoperative prognosis in sacral tumors. Romanian J Morphol Embryol 58(2):393\u2013408","journal-title":"Romanian J Morphol Embryol"},{"issue":"26","key":"5006_CR28","doi-asserted-by":"publisher","first-page":"E1622","DOI":"10.1097\/BRS.0b013e31827619d3","volume":"37","author":"SA Mindea","year":"2012","unstructured":"Mindea SA, Chinthakunta S, Moldavsky M et al (2012) Biomechanical comparison of spinopelvic reconstruction techniques in the setting of total sacrectomy. Spine (Phila Pa 1976) 37(26):E1622\u2013E1627","journal-title":"Spine (Phila Pa 1976)"},{"issue":"5","key":"5006_CR29","doi-asserted-by":"publisher","first-page":"570","DOI":"10.3171\/2017.2.SPINE161128","volume":"27","author":"M Macki","year":"2017","unstructured":"Macki M, De la Garza-Ramos R, Murgatroyd AA et al (2017) Comprehensive biomechanical analysis of three reconstruction techniques following total sacrectomy: an in vitro human cadaveric model. J Neurosurg Spine 27(5):570\u2013577","journal-title":"J Neurosurg Spine"},{"issue":"5","key":"5006_CR30","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1007\/s43390-020-00108-2","volume":"8","author":"L Fradet","year":"2020","unstructured":"Fradet L, Bianco RJ, Tatsumi R, Coleman J, Aubin C\u00c9 (2020) Biomechanical comparison of sacral and transarticular sacroiliac screw fixation. Spine Deform 8(5):853\u2013862","journal-title":"Spine Deform"},{"issue":"1S","key":"5006_CR31","doi-asserted-by":"publisher","first-page":"S151","DOI":"10.1016\/j.otsr.2016.06.023","volume":"103","author":"P Tropiano","year":"2017","unstructured":"Tropiano P, Giorgi H, Faure A, Blondel B (2017) Surgical techniques for lumbo-sacral fusion. Orthop Traumatol Surg Res 103(1S):S151\u2013S159","journal-title":"Orthop Traumatol Surg Res"},{"issue":"1","key":"5006_CR32","doi-asserted-by":"publisher","first-page":"e85298","DOI":"10.1371\/journal.pone.0085298","volume":"9","author":"Y Yu","year":"2014","unstructured":"Yu Y, Zhu R, Zeng ZL et al (2014) The strain at bone-implant interface determines the effect of spinopelvic reconstruction following total sacrectomy: a strain gauge analysis in various spinopelvic constructs. PLoS One 9(1):e85298","journal-title":"PLoS One"},{"key":"5006_CR33","doi-asserted-by":"publisher","first-page":"e216","DOI":"10.1016\/j.wneu.2019.05.113","volume":"129","author":"K Handa","year":"2019","unstructured":"Handa K, Ozawa H, Aizawa T et al (2019) Surgical management of giant sacral schwannoma: a case series and literature review. World Neurosurg 129:e216\u2013e223","journal-title":"World Neurosurg"},{"issue":"18","key":"5006_CR34","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1097\/BRS.0000000000002635","volume":"43","author":"X Tang","year":"2018","unstructured":"Tang X, Yang R, Qu H et al (2018) Factors associated with spinopelvic fixation mechanical failure after total sacrectomy. Spine (Phila Pa 1976) 43(18):1268\u20131274","journal-title":"Spine (Phila Pa 1976)"},{"issue":"3","key":"5006_CR35","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1007\/s00264-017-3645-5","volume":"42","author":"B Wang","year":"2018","unstructured":"Wang B, Hao Y, Pu F, Jiang W, Shao Z (2018) Computer-aided designed, three dimensional-printed hemipelvic prosthesis for peri-acetabular malignant bone tumour. Int Orthop 42(3):687\u2013694","journal-title":"Int Orthop"}],"container-title":["International Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-021-05006-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00264-021-05006-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-021-05006-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,7]],"date-time":"2021-05-07T01:22:13Z","timestamp":1620350533000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00264-021-05006-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,25]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["5006"],"URL":"https:\/\/doi.org\/10.1007\/s00264-021-05006-4","relation":{},"ISSN":["0341-2695","1432-5195"],"issn-type":[{"value":"0341-2695","type":"print"},{"value":"1432-5195","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,25]]},"assertion":[{"value":"20 January 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the institutional review board of our hospital.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable to this retrospective review.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors and supporting institutions have consented to publication.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}