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1/20. A persistent sinus tract from the vagina to the sacrum after treatment of mesh erosion by partial removal of a GORE-TEX soft tissue patch.

    Mesh erosion is an unfortunate complication of abdominal sacral colpopexy. A sinus tract from the vagina to the sacrum developed in a patient after partial removal of a GORE-TEX Soft Tissue Patch because of mesh erosion. Successful management eventually required complete removal of all GORE-TEX material and resection of the sinus tract.
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ranking = 1
keywords = sacrum
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2/20. Reconstruction after total en bloc sacrectomy for osteosarcoma using a custom-made prosthesis: a technical note.

    STUDY DESIGN: A report of an innovative technique to restore the lumbosacral junction after resection of primary highly malignant osteosarcoma of the sacrum involving the whole sacrum, soft tissues, and adjacent posterior parts of both iliac wings. OBJECTIVES: To describe the planning and design of a custom-made sacral prosthesis, the surgical technique, and clinical and functional outcome of the patient. SUMMARY OF BACKGROUND DATA: Although there have been case reports about reconstruction methods after total sacrectomy, to date, there has not been a reported clinical case of successful reconstruction using an individual designed prosthesis based on a three-dimensional real-sized model. methods: A 42-year-old woman was referred with progressive neurologic impairment due to primary osteosarcoma of the sacrum invading surrounding structures. Based on a three-dimensional real-sized model, a detailed surgical plan was developed to assure safe, wide surgical margins. In addition, the model enabled design and testing of a custom-made sacral prosthesis, to provide stable lumbosacral reconstruction. RESULTS: After induction chemotherapy, a staged anteroposterior resection-reconstruction was successfully performed. After surgery, a superficial wound dehiscence was promptly treated. Within 3 weeks after surgery, mobilization began, and the adjuvant chemotherapy was continued. At the 36-month follow-up, the patient was disease free, had a stable, painless spinopelvic junction, and could walk short distances using ankle orthoses and crutches. Radiographs show complete incorporation of the pelvic grafts and unchanged position of the implant. CONCLUSIONS: In planning and performing a total sacrectomy, including substantial parts of iliac wings, a three-dimensional real-sized model offers surgeons distinct advantages. Wide bony resection margins can be drawn on the model, and an individual custom-made prosthesis to re-establish spinopelvic continuity can be designed and tested before the intervention.
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ranking = 0.6
keywords = sacrum
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3/20. Early fracture of the sacrum or pelvis: an unusual complication after multilevel instrumented lumbosacral fusion.

    STUDY DESIGN: A retrospective review of a series of cases with a complication of instrumented lumbosacral fusion. OBJECTIVES: To present a previously undescribed complication, early sacral or pelvic stress fracture, after instrumented lumbosacral fusion and to identify the risk factors associated with this complication. BACKGROUND: There are a number of well-described complications of instrumented lumbosacral fusion, including delayed stress fracture of the pelvis. Early sacral or pelvic stress fracture after instrumented lumbosacral fusion has not been previously reported, to the authors' knowledge. methods: The authors present three cases of early stress fracture occurring at 2-4 weeks after surgery in patients who underwent instrumented multilevel lumbosacral fusions for degenerative lumbosacral disease. RESULTS: Two patients had sacral fracture, which to the authors' knowledge, has not been previously reported. risk factors included lumbosacral instrumentation and fusion, osteoporosis in elderly women, and iliac crest bone graft procurement. All patients were treated conservatively, with restricted ambulation and gradual return to activity. CONCLUSION: This complication can cause significant morbidity and a delay in the patient's return to function. A better understanding of the related biomechanical forces and preoperative risk factors may identify patients at risk and may aid in surgical planning and in expectations of postoperative recovery.
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keywords = sacrum
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4/20. Abdominal sacral colpopexy mesh erosion resulting in a sinus tract formation and sacral abscess.

    BACKGROUND: Complications associated with the use of synthetic mesh during an abdominal sacral colpopexy procedure include mesh infection and erosion into the vaginal vault and sacral osteomyelitis. CASE: This case report describes the management of an abdominal sacral colpopexy procedure that was complicated by postoperative vaginal mesh erosion, formation of a fistulous tract from the vaginal apex to the sacrum, and development of diskitis, osteomyelitis, and a sacral abscess. CONCLUSION: Treatment of a vaginal mesh erosion complicated by the formation of a sinus tract after abdominal sacral colpopexy should include extensive sinus tract resection in addition to complete mesh removal.
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ranking = 0.2
keywords = sacrum
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5/20. Tamponade of presacral hemorrhage with hemostatic sponges fixed to the sacrum with endoscopic helical tackers: report of two cases.

    Presacral venous hemorrhage is a severe complication in low rectal surgery. This complication was encountered in 5 of 165 patients (3 percent) who underwent a presacral dissection for rectal mobilization. Conventional hemostatic measures often are ineffective to arrest this hemorrhage, and a number of alternative hemostatic techniques have been proposed. We report the successful tamponade of presacral hemorrhage with absorbable hemostatic sponges fixed to the sacrum with endoscopic helical tackers.
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ranking = 1
keywords = sacrum
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6/20. Stress fracture of the pelvic wing-sacrum after long-level lumbosacral fusion: a case report.

    STUDY DESIGN: A case report of transverse stress fracture of the pelvic wing-sacrum after long-level lumbosacral fusion. OBJECTIVE: To report this rare complication of long-level lumbosacral fusion. SUMMARY OF BACKGROUND DATA: There are a number of well-described complications of instrumented lumbosacral fusion, including delayed stress fracture of the pelvis. A bilateral pelvic wing-sacrum transverse stress fracture after long-level lumbosacral fusion has not been previously reported to our knowledge. methods: radiography and computed tomography were used to confirm the diagnosis. Long lumbosacral fusion and a pelvic wing-sacrum fracture were shown. RESULTS: A 48-year-old woman underwent several revision spinal surgeries for collapse or instability occurring at the adjacent levels. She presented with low back and bilateral buttock pain with slow progression after last surgery. A bilateral transverse pelvic wing-sacrum stress fracture was found on plain radiographs 7 months later. CONCLUSIONS: Stress fracture of bilateral pelvic wing-sacrum can occur as a potential source of late pain after long fusions of the lumbosacral spine. A better understanding of the related biomechanical forces and preoperative risk factors may identify patients at risk and may aid in surgical planning.There are few reports of pelvic stress fracture as a complication of lumbosacral fusion, and it is typically described as a late occurrence. We present the occurrence of a bilateral pelvic wing-sacrum transverse stress fracture, not previously discussed to our knowledge.
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ranking = 2
keywords = sacrum
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7/20. Complications in the surgical treatment of lumbar stenosis.

    The authors analyze the complications which may occur in the surgical treatment of lumbar stenosis. They report 4 cases of cauda equina syndrome and 8 dural tears in 96 patients aged from 21 to 81 years submitted to multiple bilateral laminectomy. Based on a review of the patients some considerations on surgery for the treatment of lumbar stenosis are discussed. The advanced age of the patients, hypertension, diabetes, vasculopathies in general, severe neurological deficit dating back some time contraindicate surgery. When surgery is indicated a correct preoperative evaluation by MRI from T12 to the sacrum is required to determine the extent of the laminectomy and a safe and accurate intra- and postoperative bleeding control is mandatory. Dural laceration may be repaired by a thoracolumbar fascia patch.
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ranking = 0.2
keywords = sacrum
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8/20. Mesh invasion of the rectum: an unusual late complication of rectal prolapse repair.

    Various surgical techniques have been described for repair of rectal prolapse; however, there is no agreement on a standard treatment method. In the Ripstein procedure, the rectum is fixed to the sacrum with a piece of mesh material. We describe the case of a patient who had undergone a Ripstein procedure to address rectal prolapse 6 years before admission to our clinic. His complaints were anal discomfort, abdominal discomfort, and tenesmus of 2 years duration. Rectoscopy and abdominal computed tomography (CT) revealed that the mesh had penetrated the rectal wall and was located within the rectal lumen 7-8 cm from the anal verge. Once the mesh was endoscopically, and the patient's symptoms resolved completely. Various complications of mesh implantation for rectal prolapse repair have been documented, but rectal wall penetration has not been reported to date. This report presents our case of this unusual complication and reviews the relevant literature.
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ranking = 0.2
keywords = sacrum
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9/20. Large presacral schwannoma after radical prostatectomy.

    A 56-year-old man presented with long-standing, mild urinary frequency 6 years after radical prostatectomy. Pathologic assessment showed presence of organ confined prostate cancer (pT2a), Gleason 6 (3 3). Since the time of surgery, PSA level was undetectable and the patient remained without evidence of recurrent disease. However, digital rectal examination revealed the presence of a very large mass palpable on the anterior rectal wall. Therefore, the patient underwent abdominal/pelvic MRI which demonstrated presence of a solid, well-circumscribed pelvic mass extending from the level of the sacrum posteriorly to the anterior abdominal wall. Histologic examination of percutaneous biopsy of the mass was suggestive of schwannoma. The patient underwent laparotomic excision of the mass, which was confirmed to be a schwannoma, with its characteristic slender spill cells and elongate nuclei. No intra-operative complication was reported. The patient has no evidence of recurrence with complete resolution of urinary symptom one year after surgery.
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ranking = 0.2
keywords = sacrum
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10/20. cauda equina syndrome after in situ arthrodesis for severe spondylolisthesis at the lumbosacral junction.

    Relative stretching of the cauda equina over the posterosuperior border of the sacrum can be found in all patients who have Grade-III or IV spondylolisthesis at the lumbosacral junction. We identified twelve patients, all less than eighteen years old, who had cauda equina syndrome after in situ arthrodesis for Grade-III or IV lumbosacral spondylolisthesis. In all twelve patients, posterolateral arthrodesis had been done bilaterally through a midline or paraspinal muscle-splitting approach. Nothing in the operative reports suggested that the cauda equina had been directly injured during any of the procedures. Five of the twelve patients eventually recovered completely. The remaining seven patients had a permanent residual neurological deficit, manifested by complete or partial inability to control the bowel and bladder. If dysfunction of the root of the sacral nerve is noted preoperatively in a patient who has lumbosacral spondylolisthesis, decompression of the cauda equina concomitant with the arthrodesis should be considered. An acute cauda equina syndrome that follows a seemingly uneventful in situ arthrodesis for spondylolisthesis is best treated by an immediate decompression that includes resection of the posterosuperior rim of the dome of the sacrum and the adjacent intervertebral disc. In addition, posterior insertion of instrumentation and reduction of the lumbosacral spondylolisthesis should be considered.
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ranking = 0.4
keywords = sacrum
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