Sacral chordomas are locally aggressive tumors that grow slowly and often involve the sacral nerve roots leading to bladder disturbances. The treatment of these tumors involves utmost care as it can lead to tumor recurrence and neurological morbidity. We present our experience of 6 patients with sacral chordomas out of 17 patients with sacral lesions, where we have treated them with partial sacrectomies. In all of our cases, we have preserved at least one S2 root and postsurgery 83.33% of patients had intact bowel and bladder function. The lumbopelvic fixation was done in none of the cases as we have preserved the stability of the sacroiliac (SI) joint, as all osteotomy was done below S1. None of the patients had recurrence with an average follow-up of 4.1 years. This study aims at describing the surgical steps in managing a sacral chordoma.
Baratti D, Gronchi A, Pennacchioli E, Lozza L, Colecchia M, Fiore M, Santinami M. Chordoma: natural history and results in 28 patients treated at a single institution. Ann Surg Oncol 2003 Apr;10(3):291-296.
Chen KW, Yang HL, Lu J, Chen XQ. Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients. Spinal Cord 2010 Feb;48(2):166-171.
Gerber S, Ollivier L, Leclère J, Vanel D, Missenard G, Brisse H, de Pinieux G, Neuenschwander S. Imaging of sacral tumours. Skeletal Radiol 2008 Apr;37(4):277-289.
Murphey MD, Andrews CL, Flemming DJ, Temple HT, Smith WS, Smirniotopoulos JG. Primary tumors of the spine: radiologic pathologic correlation. Radiographics 1996 Sep;16(5):1131-1158.
Raque GH, Vitaz TW, Shields CB. Treatment of neoplastic diseases of the sacrum. J Surg Oncol 2001 Apr;76(4): 301-307.
Kaiser TE, Pritchard DJ, Unni KK. Clinicopathologic study of sacrococcygeal chordoma. Cancer 1984 Jun;53(11): 2574-2578.
Magrini SM, Papi MG, Marletta F, Tomaselli S, Cellai E, Mungai V, Biti G. Chordoma: natural history, treatment and prognosis. The Florence Radiotherapy Department experience (1956–1990) and a critical review of the literature. Acta Oncol 1992;31(8):847-851.
Yang H, Zhu L, Ebraheim NA, Liu J, Shapiro A, Castillo S, Liu X, Tang T. Surgical treatment of sacral chordomas combined with transcatheter arterial embolization. J Spinal Disord Tech 2010 Feb;23(1):47-52.
Gottfried ON, Schmidt MH, Stevens EA. Embolization of sacral tumors. Neurosurg Focus Aug 2003;15(2):1-4.
Karakousis C, Sugarbaker P. Sacrectomy. Musculoskeletal cancer surgery. Dordrecht: Springer; 2004. pp. 415-424.
James HE, Mulcahy JJ, Walsh JW, Kaplan GW. Use of anal sphincter electromyography during operations on the conus medullaris and sacral nerve roots. Neurosurgery 1979 Jun;4(6):521-523.
Inoue S, Kawaguchi M, Takashi S, Kakimoto M, Sakamoto T, Kitaguchi K, Furuya H, Morimoto T, Sakaki T. Intraoperative monitoring of myogenic motor-evoked potentials from the external anal sphincter muscle to transcranial electrical stimulation. Spine (Phila Pa 1976) 2002 Nov;27(21):E454-E459.
Alderink GJ. The sacroiliac joint: review of anatomy, mechanics, and function. J Orthop Sports Phys Ther 1991;13(2): 71-84.
Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat 2012;221(6):537-567.
Gunterberg B, Romanus B, Stener B. Pelvic strength after major amputation of the sacrum. An experimental study. Acta Orthop Scand 1976 Dec;47(6):635-642.
Sciubba DM, Nelson C, Gok B, McGirt MJ, McLoughlin GS, Noggle JC, Wolinsky JP, Witham TF, Bydon A, Gokaslan ZL. Evaluation of factors associated with postoperative infection following sacral tumor resection. J Neurosurg Spine 2008 Dec;9(6):593-599.
Miles WK, Chang DW, Kroll SS, Miller MJ, Langstein HN, Reece GP, Evans GR, Robb GL. Reconstruction of large sacral defects following total sacrectomy. Plast Reconstr Surg 2000 Jun;105(7):2387-2394.
