{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T16:14:11Z","timestamp":1780071251620,"version":"3.54.0"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Aggressive sacral tumors often require en bloc resection and lumbopelvic reconstruction. Instrumentation failure and pseudarthrosis remain a clinical concern to be addressed. The objective in this study was to compare the biomechanical stability of 3 distinct techniques for sacral reconstruction in vitro.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>In a human cadaveric model study, 8 intact human lumbopelvic specimens (L2\u2013pelvis) were tested for flexion-extension range of motion (ROM), lateral bending, and axial rotation with a custom-designed 6-df spine simulator as well as axial compression stiffness with the MTS 858 Bionix Test System. Biomechanical testing followed this sequence: 1) intact spine; 2) sacrectomy (no testing); 3) Model 1 (L3\u20135 transpedicular instrumentation plus spinal rods anchored to iliac screws); 4) Model 2 (addition of transiliac rod); and 5) Model 3 (removal of transiliac rod; addition of 2 spinal rods and 2 S-2 screws). Range of motion was measured at L4\u20135, L5\u2013S1\/cross-link, L5\u2013right ilium, and L5\u2013left ilium.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Flexion-extension ROM of the intact specimen at L4\u20135 (6.34\u00b0 \u00b1 2.57\u00b0) was significantly greater than in Model 1 (1.54\u00b0 \u00b1 0.94\u00b0), Model 2 (1.51\u00b0 \u00b1 1.01\u00b0), and Model 3 (0.72\u00b0 \u00b1 0.62\u00b0) (p &lt; 0.001). Flexion-extension at both the L5\u2013right ilium (2.95\u00b0 \u00b1 1.27\u00b0) and the L5\u2013left ilium (2.87\u00b0 \u00b1 1.40\u00b0) for Model 3 was significantly less than the other 3 cohorts at the same level (p = 0.005 and p = 0.012, respectively). Compared with the intact condition, all 3 reconstruction groups statistically significantly decreased lateral bending ROM at all measured points. Axial rotation ROM at L4\u20135 for Model 1 (2.01\u00b0 \u00b1 1.39\u00b0), Model 2 (2.00\u00b0 \u00b1 1.52\u00b0), and Model 3 (1.15\u00b0 \u00b1 0.80\u00b0) was significantly lower than the intact condition (5.02\u00b0 \u00b1 2.90\u00b0) (p &lt; 0.001). Moreover, axial rotation for the intact condition and Model 3 at L5\u2013right ilium (2.64\u00b0 \u00b1 1.36\u00b0 and 2.93\u00b0 \u00b1 1.68\u00b0, respectively) and L5\u2013left ilium (2.58\u00b0 \u00b1 1.43\u00b0 and 2.93\u00b0 \u00b1 1.71\u00b0, respectively) was significantly lower than for Model 1 and Model 2 at L5\u2013right ilium (5.14\u00b0 \u00b1 2.48\u00b0 and 4.95\u00b0 \u00b1 2.45\u00b0, respectively) (p = 0.036) and L5\u2013left ilium (5.19\u00b0 \u00b1 2.34\u00b0 and 4.99\u00b0 \u00b1 2.31\u00b0) (p = 0.022). Last, results of the axial compression testing at all measured points were not statistically different among reconstructions.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The addition of a transverse bar in Model 2 offered no biomechanical advantage. Although the implementation of 4 iliac screws and 4 rods conferred a definitive kinematic advantage in Model 3, that model was associated with significantly restricted lumbopelvic ROM.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.2.spine161128","type":"journal-article","created":{"date-parts":[[2017,8,4]],"date-time":"2017-08-04T14:02:15Z","timestamp":1501855335000},"page":"570-577","source":"Crossref","is-referenced-by-count":13,"title":["Comprehensive biomechanical analysis of three reconstruction techniques following total sacrectomy: an in vitro human cadaveric model"],"prefix":"10.3171","volume":"27","author":[{"given":"Mohamed","family":"Macki","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"De la Garza-Ramos","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley A.","family":"Murgatroyd","sequence":"additional","affiliation":[{"name":"Orthopaedic Spinal Research Institute, St. Joseph Medical Center, University of Maryland, Towson, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth P.","family":"Mullinix","sequence":"additional","affiliation":[{"name":"Orthopaedic Spinal Research Institute, St. Joseph Medical Center, University of Maryland, Towson, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolei","family":"Sun","sequence":"additional","affiliation":[{"name":"Orthopaedic Spinal Research Institute, St. Joseph Medical Center, University of Maryland, Towson, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan W.","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Orthopaedic Spinal Research Institute, St. Joseph Medical Center, University of Maryland, Towson, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon A.","family":"McCutcheon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziya L.","family":"Gokaslan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1097\/00007632-198205000-00014","article-title":"The Galveston technique for L rod instrumentation of the scoliotic spine","volume":"7","author":"Allen BL Jr","year":"1982","unstructured":"Allen BL Jr, Ferguson RL: The Galveston technique for L rod instrumentation of the scoliotic spine. 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