Ressecção total em bloco do sacro por via exclusivamente posterior com técnica “Catedral Modificada”: nota técnica

Carelli, Luís E.; Bianconi, Alessandro Maria; Silva, Octavio Augusto Tomé da; Barros, Alderico Girão Campos de

doi:10.1590/S1808-185120252404302237

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Technical Note: Tumor/Infection • Coluna/Columna 24 (4) • 2025 • https://doi.org/10.1590/S1808-185120252404302237 linkcopiar

Ressecção total em bloco do sacro por via exclusivamente posterior com técnica “Catedral Modificada”: nota técnica

Autoria SCIMAGO INSTITUTIONS RANKINGS

Objetivo: Descrever a técnica de sacrectomia total em bloco por abordagem exclusivamente posterior, discutindo indicações, aspectos técnicos, complicações e desfechos oncológicos disponíveis na literatura. Métodos: Relato técnico baseado em descrição cirúrgica detalhada e revisão narrativa da literatura. Resultados esperados: A abordagem exclusivamente posterior pode reduzir o tempo operatório, a perda sanguínea intraoperatória e a morbidade em comparação com a abordagem combinada. Conclusão: A sacrectomia total em bloco por via exclusivamente posterior, com reconstrução tipo catedral modificada, é uma alternativa viável e segura em casos selecionados de tumores sacrais malignos primários. Nível de Evidência V; Nota Técnica.

Descritores:
Sacro; Oncologia Cirúrgica; Neoplasias da Coluna Vertebral; Hemangioendotelioma; Neoplasias Ósseas

Autoria

person Luís E. Carelli

Surgery Performance · Methodology and Supervision

schoolNational Institute of Traumatology and Orthopaedic (INTO), Spine Center, Rio de Janeiro, RJ, BrazilNational Institute of Traumatology and Orthopaedic (INTO)BrazilRio de Janeiro, RJ, BrazilNational Institute of Traumatology and Orthopaedic (INTO), Spine Center, Rio de Janeiro, RJ, BrazilschoolSpine Institute of Rio de Janeiro (INCOL), Rio de Janeiro, RJ, BrazilSpine Institute of Rio de Janeiro (INCOL)BrazilRio de Janeiro, RJ, BrazilSpine Institute of Rio de Janeiro (INCOL), Rio de Janeiro, RJ, Brazil

0009-0006-0899-1218

person Alessandro Maria Bianconi

Surgery performance · supervision · editing

schoolResidency program in Orthopaedics and Traumatology, University of Milan, Milan, ItalyResidency program in Orthopaedics and TraumatologyItalyMilan, ItalyResidency program in Orthopaedics and Traumatology, University of Milan, Milan, ItalyschoolIRCCS Ospedale Galeazzi-Sant’Ambrogio, Milan, ItalyIRCCS Ospedale Galeazzi-Sant’AmbrogioItalyMilan, ItalyIRCCS Ospedale Galeazzi-Sant’Ambrogio, Milan, Italy

0009-0004-1606-2078

person Octavio Augusto Tomé da Silva

validation and writing – proofreading and editing

0000-0003-3471-8638

person Alderico Girão Campos de Barros

validation and writing – proofreading and editing

0000-0002-8337-7676

personCorrespondence: Luis E. Carelli. 2600, Avenida Ayrton Senna 2600, BL 4, Office II, sala 213, Barra da Tijuca, Rio de Janeiro, Brazil.
emailluiscarelli@uol.com.br

All authors declare no potential conflict of interest related to this article.

Reviewed by: Alexandre Fogaça Cristante

Study conducted by the Instituto Nacional de Traumatologia e Ortopedia - INTO, Rio de Janeiro, Brasil.

SCIMAGO INSTITUTIONS RANKINGS

National Institute of Traumatology and Orthopaedic (INTO), Spine Center, Rio de Janeiro, RJ, BrazilNational Institute of Traumatology and Orthopaedic (INTO)BrazilRio de Janeiro, RJ, BrazilNational Institute of Traumatology and Orthopaedic (INTO), Spine Center, Rio de Janeiro, RJ, Brazil

Spine Institute of Rio de Janeiro (INCOL), Rio de Janeiro, RJ, BrazilSpine Institute of Rio de Janeiro (INCOL)BrazilRio de Janeiro, RJ, BrazilSpine Institute of Rio de Janeiro (INCOL), Rio de Janeiro, RJ, Brazil

Residency program in Orthopaedics and Traumatology, University of Milan, Milan, ItalyResidency program in Orthopaedics and TraumatologyItalyMilan, ItalyResidency program in Orthopaedics and Traumatology, University of Milan, Milan, Italy

IRCCS Ospedale Galeazzi-Sant’Ambrogio, Milan, ItalyIRCCS Ospedale Galeazzi-Sant’AmbrogioItalyMilan, ItalyIRCCS Ospedale Galeazzi-Sant’Ambrogio, Milan, Italy

Figuras

Figuras (3)

Thumbnail

Figure 1 38-years old female with low back pain and sphincter dysfunction was diagnosed epithelioid hemangioendothelioma. A - CT in sagittal plane revealing multiple expansible lytic lesions. B – MRI showing tumor expansion into the epidural space. C – Arteriography study of the sacral tumor. D - Blunt digital dissection is performed proximally and distally using the index fingers to create an anterior plane separating the vascular structures and the lumbosacral trunk. E - A silicone tube is introduced, followed by the passage of a wire saw through the tube. The Gigli saw handles are then attached, and the osteotomy is performed in a posterolateral direction. F - For the Cathedral reconstruction, docking sites are created centrally in the lowest remaining vertebral body and bilaterally in the iliac wings.

Thumbnail

Figure 2 Intraoperative images of En Bloc Total Sacrectomy. A – Blunt digital dissection. B and C - Gigli saw handles are then attached, and the osteotomy is performed. D – Intraoperative view of the tumor specimen. E – Preparation of docking sites in vertebral body for Cathedral reconstruction. F and G - A vascularized fibula was used on the left side and anastomosed to a branch of the left superior gluteal artery.

Thumbnail

Figure 3 A, B and C - Digital photos of the surgical specimen and macroscopic specimen of pathological anatomy. D – Four-rods construction and Modified Cathedral technique with a third fibula graft spanning from L4 to the ilium to enhance posterior stability with interference screws. E and F – Coronal and sagittal views of the fibular structural grafts from L5 to iliac ring.

imageFigure 1 38-years old female with low back pain and sphincter dysfunction was diagnosed epithelioid hemangioendothelioma. A - CT in sagittal plane revealing multiple expansible lytic lesions. B – MRI showing tumor expansion into the epidural space. C – Arteriography study of the sacral tumor. D - Blunt digital dissection is performed proximally and distally using the index fingers to create an anterior plane separating the vascular structures and the lumbosacral trunk. E - A silicone tube is introduced, followed by the passage of a wire saw through the tube. The Gigli saw handles are then attached, and the osteotomy is performed in a posterolateral direction. F - For the Cathedral reconstruction, docking sites are created centrally in the lowest remaining vertebral body and bilaterally in the iliac wings. open_in_new

imageFigure 2 Intraoperative images of En Bloc Total Sacrectomy. A – Blunt digital dissection. B and C - Gigli saw handles are then attached, and the osteotomy is performed. D – Intraoperative view of the tumor specimen. E – Preparation of docking sites in vertebral body for Cathedral reconstruction. F and G - A vascularized fibula was used on the left side and anastomosed to a branch of the left superior gluteal artery. open_in_new

imageFigure 3 A, B and C - Digital photos of the surgical specimen and macroscopic specimen of pathological anatomy. D – Four-rods construction and Modified Cathedral technique with a third fibula graft spanning from L4 to the ilium to enhance posterior stability with interference screws. E and F – Coronal and sagittal views of the fibular structural grafts from L5 to iliac ring. open_in_new

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