Total Sacrectomy and Reconstruction with Structural Allografts for Neurofibrosarcoma of the Sacrum

P rimary neurofibrosarcomas of the sacrum are rare and have been reported only sporadically in the literature1-3. Because of the anatomic location, sacral tumors are often diagnosed only when they have reached a large size involving neighboring structures, thus limiting the potential for a curative resection. The treatment of choice for aggressive sacral tumors is radical resection. Large sacral tumors require extensive surgery to achieve adequate margins, and reconstruction to provide stability between the spine and pelvis is a challenging problem. The complete removal of the sacrum leaves the lumbopelvic complex so unstable that, without reconstruction, a prolonged period of pain and rehabilitation is the usual result4-6. Descriptions of methods to reconstruct the pelvis after sacrectomy have included the use of autologous bone grafts, allografts, autoclaved parts of the resected sacrum, or metal prostheses7-17. We report the case of a patient with a large primary neurofibrosarcoma in the sacrum and describe the technique we used for extended total en bloc sacrectomy and primary reconstruction with use of structural tibial allografts. After five years of follow-up, the patient was disease-free and walking independently. Our patient was informed that data concerning the case would be submitted for publication. A thirty-five-year-old woman presented with a six-month history of progressive pain in the lumbosacral region radiating into both legs and episodes of bladder incontinence that had occurred during the latest three months. She had diminished sensation bilaterally in the S1 through S4 dermatomes and weakness in the left lower leg and foot. Signs of cauda equina compressions were present on the left side. An osteolytic lesion in the sacrum was seen on plain radiographs. Magnetic resonance imaging (Fig. 1) showed a large mass in the sacrum penetrating the anterior cortex, infiltrating into …