Wide resection of sacral chordoma via a posterior approach

Abstract

Purpose: The study was carried out to report the results of wide resection in sacral chordoma using a posterior approach and gauze packing technique.

Materials and methods: The study was carried out between 1990 and 2002; there were 21 patients who underwent the operation. Fourteen patients were male and seven were female. Their ages ranged between 29 and 75 years. Most of the patients presented with sacral mass, pain and neurological deficit. Total sacrectomy and bone reconstruction were carried out in 12 patients. Subtotal sacrectomy was carried out in the remaining nine patients. All patients were followed up for at least seven years.

Results: All survived after the operation. Operative time ranged between five and ten hours. All patients needed blood transfusion which ranged between four and 11 units. After the operation, all patients had a certain degree of bowel and bladder dysfunction. Five patients had local complications including infection in three patients with wound disruption and two patients with a seroma. During the follow-up, three patients (14%) had tumour recurrence and one of the patients expired. The remaining 18 patients were still tumour-free at the seven-year follow-up.

Conclusion: Wide resection via the posterior approach and gauze packing technique could be used for management of sacral chordoma with acceptable results.

Figures

Fig. 1

Dissection was done along the anterior aspect of the posterior iliac crests and a certain number of rolled gauzes with radio-opaque labels were used to pack under the iliac crests and anterior to the body of lower lumbar vertebra and sacrum to push visceral organs and great vessels away from the bones

Fig. 2

Gauze packing could protect visceral organs and great vessels from bone cutting with an osteotome

Fig. 3

After the body of the upper most vertebra and the iliac wings were cut, the sacrum with the tumor could be rotated backward by the use of a bone hook

Fig. 4

The cut sacrum with the tumor was easily mobilized to facilitate blunt and sharp dissection between the tumor mass and visceral organs. Furthermore, packed gauze could minimize bleeding

Fig. 5

The removed tumor was examined for free margin