Expert's comment concerning Grand Rounds case entitled "a novel 'pelvic ring augmentation construct' for lumbo-pelvic reconstruction in tumor surgery" (by Sathya Thambiraj, Daren Forward, James Thomas and Bronek Boszczyk)

Abstract

Introduction: Historically, metastatic spine tumor surgery has been palliative for pain control, to maintain neurologic and ambulatory function. The thought of curing cancer with limited metastatic disease by resecting the primary and the metastatic lesions is becoming more common. Multilevel spondylectomy for resection of metastatic disease has been reported in the literature, mostly at the thoracic or lumbar level with some success. Reconstruction of the lumbosacral junction after tumor resection is a difficult endeavor and several techniques have been utilized. Subcutaneous anterior pelvic fixation has been described for the treatment of unstable pelvic fractures.

Materials and methods: Review of the Grand Rounds case "A novel Pelvic Ring Augmentation Construct for Lumbo-Pelvic Reconstruction in Tumour Surgery" by Sathya Thambiraj, Daren Forward, James Thomas, Bronek Boszczyk and review of the pertinent literature.

Conclusion: The authors describe a novel percutaneous rod technique and construct for buttressing a posterior spinal construct to a subcutaneous anterior pelvic fixator after tumor resection of the lumbo-pelvic junction. They manage to salvage a difficult situation for which they should be commended. This technique may be useful in situations where instrumentation has to be preformed to the pelvis: i.e., in tumor reconstruction, fusions such as neuromuscular scoliotic disease to the pelvis, to augment a lumbo-pelvic construct when a nonunion occurs or in osteoporotic patients as a salvage procedure.