Sacral Reconstruction with a 3D-Printed Implant after Hemisacrectomy in a Patient with Sacral Osteosarcoma: 1-Year Follow-Up Result

Pelvic reconstruction after sacral resection is challenging in terms of anatomical complexity, excessive loadbearing, and wide defects.Nevertheless, the technological development of 3D-printed implants enables us to overcome these difficulties.Here, we present a case of sacral osteosarcoma surgically treated with hemisacrectomy and sacral reconstruction using a 3D-printed implant.The implant was printed as a customized titanium prosthesis from a 3D real-sized reconstruction of a patient's CT images.It consisted mostly of a porous mesh and incorporated a dense strut.After 3-months of neoadjuvant chemotherapy, the patient underwent hemisacretomy with preservation of contralateral sacral nerves.The implant was anatomically installed on the defect and fixed with a screw-rod system up to the level of L3.Postoperative pain was significantly low and the patient recovered sufficiently to walk as early as 2 weeks postoperatively.The patient showed left-side foot drop only, without loss of sphincter function.In 1-year follow-up CT, excellent bony fusion was noticed.To our knowledge, this is the first report of a case of hemisacral reconstruction using a custom-made 3D-printed implant.We believe that this technique can be applied to spinal reconstructions after a partial or complete spondylectomy in a wide variety of spinal diseases.