A combined anterior and posterior approach was used for the resection of
a large tumor (a chordoma, a giant-cell tumor, an osteosarcoma, or a
chondrosarcoma) of the cephalad part of the sacrum in twelve patients. The
anterior aspect of the sacrum was exposed through an extended ilioinguinal
approach, and the posterior aspect, through a midline approach. This widely
extensile procedure permitted simultaneous visualization of the anterior,
posterior, and circumferential aspects of the sacrum at the time of the
osteotomy and facilitated the resection of these difficult lesions. At the
time of follow-up (average duration for the eleven surviving patients,
thirty-seven months; median, thirty months; range, twenty to sixty-nine
months), ten patients were able to walk independently (four with the use of
a cane) and one was confined to a wheelchair. One patient had died
immediately postoperatively. The results of the present study indicate that
a combined extended ilioinguinal and posterior approach can be used
effectively for the wide resection of a tumor arising in the cephalad part
of the sacrum.