Novel use of a threadwire saw for high sacral amputation. Technical note and description of operative technique

The authors describe and demonstrate an innovative modification of the osteotomy procedure required to achieve a supraforaminal high sacral amputation in a patient harboring a large sacral chordoma. Via a combined anterior-posterior approach, three carefully placed threadwire saws were used to create releasing osteotomies through specific portions of the dorsal iliac crests and through the axial midportion of the S-1 vertebral body. The threadwire saws are pulled away from neurovascular and visceral structures, ensuring greater protection. Other advantages include markedly reduced blood loss while performing the osteotomies, a high degree of cutting accuracy, negligible bone loss, and ease and speed of bone cutting.