European Spine Journal

, Volume 28, Issue 6, pp 1461–1467 | Cite as

The extended posterior approach for resection of sacral tumours

  • S. P. Mohanty
  • Madhava Pai KanhangadEmail author
  • Raghuraj Kundangar
Original Article



The conventional posterior approach is mostly advocated for excision of sacral tumours below S2. We describe an operative technique of single-stage en bloc resection of sacral tumours, extending up to S1, through an extended posterior approach.


Nine patients, who had undergone resection of sacral tumours, by the described technique formed the basis of this study. Four patients had chordomas, whereas schwannoma, neurilemmoma, giant-cell tumour, malignant paraganglioma and recurrent Ewing’s sarcoma were seen in one patient each. They were followed up at regular intervals with a mean follow-up of 45.4 months. Perioperative complications, their functional and oncological outcomes at final follow-up were analysed.


None of the patients had any perioperative complications like uncontrolled haemorrhage, injury to the rectum, deep vein thrombosis or pulmonary embolism. One patient had a superficial wound infection which subsided with regular dressing, and another patient developed a wound breakdown that required an additional flap procedure. At final follow-up, six patients were able to walk without any assistive devices, six patients had normal bladder function, and five patients had normal bowel function. Five patients did not have any recurrence at final follow-up, whereas two were alive with the disease and two had died.


The reported technique allows en bloc resection of sacral tumours up to S1, through a posterior-only approach. It is less invasive with minimal morbidity. The functional and oncological outcomes are similar to those reported by other investigators.

Graphical abstract

These slides can be retrieved from electronic supplementary material.


Sacral tumours Surgical resection Posterior approach 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Institutional ethical clearance was obtained before starting the study.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Gennari LE, Azzarelli AL, Quagliuolo VI (1987) A posterior approach for the excision of sacral chordoma. Bone Joint J 69(4):565–568Google Scholar
  2. 2.
    Angelini A, Ruggieri P (2013) A new surgical technique (modified Osaka technique) of sacral resection by posterior-only approach: description and preliminary results. Spine 38(3):E185–E192CrossRefGoogle Scholar
  3. 3.
    Schwab JH, Healey JH, Rose P, Casas-Ganem J, Boland PJ (2009) The surgical management of sacral chordomas. Spine 34(24):2700–2704CrossRefGoogle Scholar
  4. 4.
    Waisman M, Kligman M, Roffman M (1997) Posterior approach for radical excision of sacral chordoma. Int Orthop 21(3):181–184CrossRefGoogle Scholar
  5. 5.
    Asavamongkolkul A, Waikakul S (2012) Wide resection of sacral chordoma via a posterior approach. Int Orthop 36(3):607–612CrossRefGoogle Scholar
  6. 6.
    Hulen CA, Temple HT, Fox WP, Sama AA, Green BA, Eismont FJ (2006) Oncologic and functional outcome following sacrectomy for sacral chordoma. JBJS 88(7):1532–1539CrossRefGoogle Scholar
  7. 7.
    Fuchs B, Dickey ID, Yaszemski MJ, Inwards CY, Sim FH (2005) Operative management of sacral chordoma. JBJS 87(10):2211–2216Google Scholar
  8. 8.
    Guo W, Tang X, Zang J, Ji T (2013) One-stage total en bloc sacrectomy: a novel technique and report of 9 cases. Spine 38(10):E626–E631CrossRefGoogle Scholar
  9. 9.
    Wei G, Xiaodong T, Yi Y, Ji T (2009) Strategy of surgical treatment of sacral neurogenic tumors. Spine 34(23):2587–2592CrossRefGoogle Scholar
  10. 10.
    Gallia GL, Haque R, Garonzik I, Witham TF, Khavkin YA, Wolinsky JP, Suk I, Gokaslan ZL (2005) Spinal pelvic reconstruction after total sacrectomy for en bloc resection of a giant sacral chordoma. J Neurosurg Spine 3(6):501–506CrossRefGoogle Scholar
  11. 11.
    Zhang HY, Thongtrangan I, Balabhadra RS, Murovic JA, Kim DH (2003) Surgical techniques for total sacrectomy and spinopelvic reconstruction. Neurosurg Focus 2:1–10CrossRefGoogle Scholar
  12. 12.
    Dickey ID, Hugate RR Jr, Fuchs B, Yaszemski MJ, Sim FH (2005) Reconstruction after total sacrectomy: early experience with a new surgical technique. Clin Orthop Relat Res 438:42–50CrossRefGoogle Scholar
  13. 13.
    Wuisman P, Lieshout O, Sugihara S, van Dijk M (2000) Total sacrectomy and reconstruction: oncologic and functional outcome. Clin Orthop Relat Res 381:192–203CrossRefGoogle Scholar
  14. 14.
    Todd LT Jr, Yaszemski MJ, Currier BL, Fuchs B, Kim CW, Sim FH (2002) Bowel and bladder function after major sacral resection. Clin Orthop Relat Res 397:36–39CrossRefGoogle Scholar
  15. 15.
    Osaka S, Kodoh O, Sugita H, Osaka E, Yoshida Y, Ryu J (2006) Clinical significance of a wide excision policy for sacrococcygeal chordoma. J Cancer Res Clin Oncol 132(4):213–218CrossRefGoogle Scholar
  16. 16.
    Nakamura A, Mori K, Nishizawa K, Imai S (2015) Current status of the treatment for sacral chordomas and its future trends. Open Bone J. 7(1):19–23CrossRefGoogle Scholar
  17. 17.
    Azzarelli A, Quagliuolo V, Cerasoli S, Zucali R, Bignami P, Mazzaferro V, Dossena G, Gennari L (1988) Chordoma: natural history and treatment results in 33 cases. J Surg Oncol 37(3):185–191CrossRefGoogle Scholar
  18. 18.
    Cummings BJ, Hodson DI, Bush RS (1983) Chordoma: the results of megavoltage radiation therapy. Int J Radiat Oncol Biol Phys 9(5):633–642CrossRefGoogle Scholar
  19. 19.
    Zabel-du Bois A, Nikoghosyan A, Schwahofer A, Huber P, Schlegel W, Debus J, Milker-Zabel S (2010) Intensity modulated radiotherapy in the management of sacral chordoma in primary versus recurrent disease. Radiother Oncol 97(3):408–412CrossRefGoogle Scholar
  20. 20.
    Yamada Y, Laufer I, Cox BW, Lovelock DM, Maki RG, Zatcky JM, Boland PJ, Bilsky MH (2013) Preliminary results of high-dose single-fraction radiotherapy for the management of chordomas of the spine and sacrum. Neurosurgery 73(4):673–680CrossRefGoogle Scholar
  21. 21.
    Lin CL, Fang JJ, Lin RM (2016) Resection of giant invasive sacral schwannoma using image-based customized osteotomy tools. Eur Spine J 25(12):4103–4107CrossRefGoogle Scholar
  22. 22.
    Yin J, Wu H, Tu J, Zou C, Huang G, Xie X, He Y, Shen J (2018) Robot-assisted sacral tumor resection: a preliminary study. BMC Musculoskelet Disord 19:186CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Spine Surgery, Department of Orthopaedics, Kasturba Medical CollegeManipal Academy of Higher EducationManipalIndia

Personalised recommendations