Surgical Excision of Large Sacral Chordoma with Lumbopelvic Fixation

Abstract

Background: Chordoma is slowly growing locally malignant destructive tumor originated as a remnant of notochord. It occur less than 5% of all bone tumors. It has a preferentiality to attack sacrum up to 50%, followed by base of the skull up to 40% and to less extent other vertebral regions up to 15%. Local pain, radiculopathy, and urinary incontinence are the usual presenting symptoms in case of Sacral Chordoma. Contrast enhanced MRI and CT are recommended studies to evaluate extent of both soft tissue invasion and displacement and bone destruction and calcification. This lesion is resistant to chemotherapy and weak response to radiotherapy make the surgical excision first line of treatment. Aggressive surgical excision and stabilization of lumbosacral spin and pelvis improve the local control in spite of risk of associated morbidity. Sacral Chordoma is reported to be poor prognosis. The optimal method for management of this lesion is debatable due to its rarity. Aim: To present a case of Sacral Chordoma with very large local extension and sacral destruction. Study design: Case report. Methods: our 60 years old male patient presented with lower lumbar and sacral swelling, bilateral gluteal pain, and obstructive uropathy. Slowly progressive within the last nine months prior to presentation; contrast enhanced MRI and CT lumbosacral spine, show a large sacral destructive heterogeneous mass lesion destructing the sacrum and intraspinal structures apart from first sacral segment. By CT guided biopsy at oncology institute diagnosed as Sacral Chordoma. He was subjected to gross surgical total excision, and posterior lumbosacral transpedicular screw fixation concomitant with iliac screw for sacral augmentation, then adjuvant radiation therapy. Results: After tumor excision and lumbopelvic fixation, the patient still incontinent, full motor power of both lower limbs. Complete course of adjuvant radiation. And after one year follow up the patient died due to bad general condition. Conclusion: Sacral Chordoma is infrequent lesion that affect male more than females. Gross surgical excision is the first line of treatment. Lumbopelvic stabilization is mandatory when extensive sacral destruction exist. Sacral Chordoma reported to be poor prognosis.