Orthopaedic Oncology

Internal hemipelvectomy is a technically demanding surgical procedure performed for the treatment of pelvic tumors. During the procedure, a portion of the pelvis is removed while preserving blood supply and nerve function to the limb. Various reconstructive options are available to the surgeon depending on the exact location of the tumor. In 2011, the Orthopaedic Oncology department established the multidisciplinary Pelvic Sarcoma Team. This encompasses over 14 physicians from different surgical subspecialties who are dedicated to the care of pelvic sarcoma patients.

Resection of a sarcoma involves removal of the tumor with a cuff of normal tissue - this ensures the entire removal of the tumor. This can require the removal of an entire muscle group, the lining of the bone and ligaments or tendons. Expertise in limb salvage facilitates the best functional outcomes for the patient. Resection should be performed in a manner to maximize both oncologic and functional outcome.

Removing bone tumors in children frequently requires removal of one of more of the bone's growth plates. This can result in significant shortening of the limb when compared to the unaffected limb that continues to grow normally. Expandable prostheses can be used to non-invasively lengthen the limb. This is done by lengthening the prosthesis in small increments over time. The lengthening process is performed during follow up clinic visits and is done without further surgery or anesthesia. 

En bloc spinal resection is complex surgery designed to remove tumors within the bones of the spine. The goal of an en bloc resection is to achieve a complete resection of the tumor in one piece, decreasing the risk of tumor spread during removal. Multiple vertebrae may be removed. Once the tumor has been removed, spine reconstruction is performed to maintain spine stability and maximize function.

A rotationplasty involves removing the impacted portion of the bone together with the knee joint, then rotating the lower portion of the leg 180 degrees before reattaching it. Because of the rotation of the lower limb, the ankle is now on the same plane where the knee used to be, with the foot and toes pointing backward and the heel facing forward. The ankle now bends where the knee used to bend. In pre-operative planning, the physician will take into account the age of the child and their growth potential. Given the prediction of growth remaining, the surgeon will incorporate this into the surgical-resection plan. The knee centers of both the operative and non-operative side will be equal when the child stops growing.

Computer assisted navigation surgery is specialized surgery utilizing complex 3D imaging in real time to help the surgeon localize the tumor and the surrounding critical structures. This helps the surgeon navigate complex anatomy often distorted by the tumor. This surgery improves the accuracy, precision, and safety of the procedure and is commonly used in spine, sacral and pelvic tumor resections at MD Anderson Cancer Center.

At MD Anderson Cancer Center, our surgical capabilities in treating sacral tumors are at the forefront of oncological and spinal surgery. We specialize in performing total sacrectomies, complex nerve-sparing partial sacrectomies, and sacropelvic stabilization procedures, each tailored to the patient's unique condition. Our approach integrates computer-assisted surgical planning with 3D anatomical modeling, enhancing the precision of tumor localization and resection. This advanced technique, coupled with intraoperative CT navigation, allows for the meticulous removal of tumors while preserving critical nerve roots, thereby maximizing post-operative functional outcomes.

The use of computer-assisted navigation surgery is pivotal in our procedures, leveraging real-time complex 3D imaging to navigate through the distorted anatomy caused by tumors. This technology significantly improves the accuracy, precision, and safety of sacral surgeries, making it an invaluable tool in our surgical repertoire. Our dedication to integrating cutting-edge technology with surgical expertise underscores our commitment to providing the highest standard of care for patients undergoing sacral surgeries at MD Anderson.