Medical Student Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Introduction: Sacral tumors are rare lesions for which surgical resection remains the mainstay of treatment; however, en-bloc sacrectomy typically requires sacrifice of nerve roots distal to tumor resection, resulting in bowel and bladder functional impairment. Relative nerve preservation (RNP) is a rarely-described technique that aims to preserve sacral spinal roots when possible, including unilateral sparing. Here, we describe our experience with en-bloc sacrectomy and sacral RNP, and assess whether RNP yields improved clinical outcomes.
Methods: We retrospectively identified patients that underwent en-bloc sacrectomy between 2021 and 2022 to include in this study. Pre-procedure, procedural, and post-procedure characteristics were collected. Bowel, bladder, and motor function were assessed and quantified. Procedures were classified as low (S3-S5), high (S2-S5), and total sacrectomy (S1-S5).
Results: Twelve patients who underwent en-bloc sacrectomy were identified (3 middle, 3 high, 6 total sacrectomy). RNP was utilized in 6 cases and at multiple levels (1 middle, 3 high, 1 total). Mean scored bowel and bladder deficit following sacrectomy without RNP was 2.17 +/ 1.60 compared to 2.67 +/ 1.63 with RNP (p=0.604). Change in scored bowel and bladder function (relative to pre-procedure) without RNP was 1.67 +/ 1.63 compared to 2.67 +/ 1.63 with RNP (p=0.314). 30-day readmission rates were 67% for RNP and 33% for non-RNP (p=0.567) and rates of wound infection were 33% for both RNP and non-RNP.
Conclusion : RNP is a viable procedural modification in en-bloc sacrectomy. Controlled trials are required to better elucidate improvements in bowel and bladder function. Future analysis will also investigate effect of RNP on procedural workflow, including total operating time.
