Nerve Root Sparing en Bloc Resection of Sacral Chondrosarcoma: Technical Note and Review of the Literature

Sutipat Pairojboriboon, Amanda Sacino, Zach Pennington, Daniel Lubelski, Robin Yang, Carol D. Morris, Ian Suk, Daniel M. Sciubba, Sheng Fu Larry Lo

Research output: Contribution to journalReview articlepeer-review


BACKGROUND: Total en bloc sacrectomy provides the best long-term local control for large primary bony sacral tumors, but often requires lumbosacral nerve root sacrifice leading to loss of ambulation and/or bowel, bladder, and/or sexual dysfunction. Nerve-sparing techniques may be an option for some patients that avoid these outcomes and accordingly improve postoperative quality of life. OBJECTIVE: To describe the technique for a posterior-only en bloc hemisacrectomy with maximal nerve root preservation and to summarize the available literature. METHODS: A 38-yr-old woman with a 7.7 × 5.4 × 4.5 cm biopsy-proven grade 2 chondrosarcoma involving the left L5-S2 posterior elements underwent a posterior-only left hemisacrectomy tri-rod L3-pelvis fusion. A systematic review of the English literature was also conducted to identify other descriptions of high sacrectomy with distal sacral nerve root preservation. RESULTS: Computer-aided navigation facilitated an extracapsular resection that allowed preservation of the left-sided L5 and S3-Co roots. Negative margins were achieved and postoperatively the patient retained ambulation and good bowel/bladder function. Imaging at 9-mo follow-up showed no evidence of recurrence. The systematic review identified 4 prior publications describing 6 total patients who underwent nerve-sparing sacral resection. Enneking-appropriate resection was only obtained in 1 case though. CONCLUSION: Here we describe a technique for distal sacral nerve root preservation during en bloc hemisacrectomy for a primary sacral tumor. Few prior descriptions exist, and the present technique may help to reduce the neurological morbidity of sacral tumor surgery.

Original languageEnglish (US)
Pages (from-to)497-506
Number of pages10
JournalOperative Neurosurgery
Issue number6
StatePublished - Dec 1 2021


  • Chondrosarcoma
  • En bloc
  • Enneking system
  • Hemisacrum
  • Intraoperative navigation
  • Nerve sacrifice
  • Nerve-sparing
  • Sacrectomy
  • Systemic review
  • Technical note

ASJC Scopus subject areas

  • General Medicine


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