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Residual neurological function after sacral root resection during en-bloc sacrectomy: a systematic review
Carmine Zoccali1, Jesse Skoch2, Apar S Patel2
1Oncological Orthopaedics Department, Muscular-skeletal Tissue Bank, IFO - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. carminezoccali@libero.it.
Summary
Sacrectomy surgery can impact motor, bladder, and bowel functions. Preserving specific sacral nerve roots, particularly S3, significantly improves the chances of retaining these vital functions post-operation.
Area of Science:
- Neurosurgery
- Oncology
- Rehabilitation Medicine
Background:
- Sacrectomy is a critical surgical intervention for sacral and pelvic tumors.
- The procedure carries risks of functional deficits, including motor, sensory, and autonomic impairments.
- Existing literature on functional outcomes is limited to small case series.
Purpose of the Study:
- To comprehensively review and analyze residual motor function, gait, sensation, and bladder, bowel, and sexual function following sacrectomies.
- To correlate functional outcomes with the specific sacral nerve roots sacrificed during surgery.
Main Methods:
- An exhaustive literature search was performed for studies published before May 2015.
- Included were 15 retrospective case series comprising 244 patients.
- Studies were selected based on clear correlations between nerve root level and functional outcomes.
Main Results:
- Normal ambulation was achieved in 56.2% (S2 spared) to 100% (distal resections) of cases.
- Bladder and bowel function were compromised when both S2 roots were cut, improving with S3 root preservation.
- Preserving at least one S4 root ensured 100% normal bladder and bowel function; unilateral resections generally yielded better outcomes.
Conclusions:
- Total sacrectomy can compromise motor, bladder, bowel, sensory, and sexual functions.
- Residual motor function is linked to sparing L5 and S1 nerve roots.
- Preserving S3 nerve roots is crucial for maintaining bladder and bowel function, with unilateral resections often preserving more normal function.
