A 25-year experience with hemicorporectomy for terminal pelvic osteomyelitis.

BACKGROUND: Hemicorporectomy involves amputation of the pelvis and lower extremities by disarticulation through the lumbar spine with concomitant transection of the aorta, inferior vena cava, and spinal cord. In addition, conduits are constructed for diversion of both the urinary and fecal streams. Of 57 cases reported in the literature, limited experience exists with hemicorporectomy for terminal pelvic osteomyelitis, with only 11 cases described. Furthermore, there is little information available regarding perioperative mortality and long-term survival. This article describes the largest reported series of hemicorporectomies performed for terminal pelvic osteomyelitis. METHODS: A retrospective review of the medical records for nine patients who underwent hemicorporectomy at the authors' institution was conducted followed by interviews with all surviving patients. RESULTS: At follow-up, four patients were alive and five patients were dead. For all patients, the average survival after hemicorporectomy was 11.0 years (range, 1.7 to 22.0 years). There was no perioperative mortality within 30 days of surgery. None of the surviving patients suffered from recurrent decubitus ulcers. CONCLUSIONS: Including this clinical series, a total of 66 hemicorporectomies have now been reported in the literature. Twenty cases were performed for terminal pelvic osteomyelitis with no mortality within 30 days of surgery, and 53.3 percent of patients were alive and well at long-term follow-up. Given the low perioperative mortality along with the ability of patients to achieve long-term survival following this operation, hemicorporectomy should be offered to appropriate patients suffering from terminal pelvic osteomyelitis.

Hemicorporectomy: back to front.

Hemicorporectomy involves amputation of the pelvis and lower extremities by disarticulation through the lumbar spine with concomitant transection of the aorta, inferior vena cava, and spinal cord, as well as creation of conduits for diversion of the urinary and fecal streams. A review of the literature reveals that the surgical technique has been relatively unchanged since 1960. The standard anterior to posterior approach is associated with significant blood loss and morbidity, likely contributing to lengthy hospital stay. Herein, we describe our back-to-front approach to hemicorporectomy, involving early division of the vertebral structures and spinal cord, pre-empting engorgement of Batson's plexus, thus minimizing blood loss. In addition, this approach greatly improves exposure of the pelvic vessels, allowing for a technically less challenging and safer procedure.