Clinical manifestations, classification, and surgical management of sacral tumors and the need for personalized approach to sacrectomy

Abstract

Background: Although comprising 7% of all spinal tumors, sacral tumors present with a litany of issues due to their slow growth and difficulty in detection. As a result, sacral tumors can grow unperturbed for years until a patient presents for an incidental workup of an unassociated minor trauma or an offending primary tumor source that has metastasized to the sacrum; in most cases, this includes primary tumors of the breast, prostate, and lung. The goal of this review is to outline the pathophysiology underlying sacral tumors including the various tissues and structures that can be targeted for treatment, along with a discussion of the surgical approach to sacrectomy. Methods: An extensive review of the published literature was conducted through PubMed database with articles simultaneously containing both search terms “sacral tumors” and “sacrectomy.” No date restrictions were used. Results: The search yielded 245 related articles. Cross-checking of articles was conducted to exclude of duplicate articles. The articles were screened for their full text and English language availability. We finalized those articles pertaining to the topic. Conclusion: Once a sacral tumor has reached the point of diagnostic detection, invasive sacrectomy is typically utilized (through an anterior, posterior, or combination approach) to locally isolate and resect the tumor and minimize risk of future tumor growth and additional bone loss. While institutions have varying criteria for surgical approaches, a combination of anterior and posterior approach has traditionally been used in total and high sacrectomies due to the control it provides surgeons toward the rectum and vasculature anterior to the sacrum. A posterior-only approach can be performed for tumors that failed to invade pelvic organs or extend past the lumbosacral junction. Early detection with screenings can help avoid invasive sacrectomy by identifying the onset of tumor formation in the sacrum, particularly for highly metastatic cancers.

A Case Report of a Sacral Giant Cell Tumor Treated With Block Resection and Lumbo-Pelvic Fixation

“…The extent of resection of the sacrum can also cause lumbo-pelvic instability. Thus, the amount of resection, determining the surgical borders, and the possibility of root sacrifice are vital in predicting the functional outcome of the patient [ 7 ]. The patient in this case benefited most from a left sacrectomy with wide surgical borders and the excision of the left sacroiliac joint, which warranted instrumentation to avoid instability.…”

Cordoma sacrococcígeo: revisión del tema

“…Clinical signs are usually non-specific 8,12,21 and depend on the lesion's anatomic location 9,20 and size. 9,14 Chordomas are indolent-slow-growing masses, therefore they are often clinically silent until late stages of the disease. 9 Sacral chordoma results in chronic back pain or urinary/bowel dysfunction due to nerve root compression.…”

“…20 Most of the sacrococcygeal chordomas are initially presented with a considerable extra axial tumoral growth, 22 and often palpated as a mass on rectal examination. 13,14 Anterior expansion into the presacral space with unilateral impingement of S2 or S3 is usually associated with mild -to-moderate bladder, bowel, and sexual dysfunction, while bilateral affection usually result in complete dysfunction. 14 The rectum is not involved anteriorly through the presacral fascia.…”

“…Conventional chordoma, dedifferentiated chordoma and poorly differentiated chordoma. [3][4][5] Chordoma represents only 1-4% of all primary malignant bone neoplasms, [6][7][8][9][10][11] is the most common primary malignant tumor within the spine, 6 is the most common tumor of any type involving the sacrum, 6,[12][13][14][15] and approximately 50% of all chordomas are sacrococcygeal in origin. 6,13,16,17 Chordoma treatment is eminently surgical through wide or radical Cirugía de Columna | 2024; 2 (2): 104-111 resection (partial sacrectomy, total sacrectomy or extended sacrectomy), and is usually associated with important sequelae mainly related to sphincter control.…”

Sacrococcygeal Tumor – A Rare Case Report

“…Although usually noncancerous, there's a possibility of recurrence or transformation into other tumor types. 1,2 Patients with SCT often encounter gastrointestinal, urological, and neurological issues, affecting their quality of life. Due to its rarity and absence of standardized management, numerous clinical questions remain unanswered.…”