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The authors present a case of mesenchymal chondrosarcoma located in the sacrum of a 23-year-old patient treated with radiotherapy and chemotherapy. A review of the literature on the topic is also reported.
A case report of a 53-year-old woman with giant cell tumour of the sacrum is presented. Initial curettage was performed through a posterior approach and the patient was relieved of pain and discharged. However, 6 months later the patient was readmitted with a tumour that had progressed towards the L5 vertebra. A further curettage followed by adjuvant radiotherapy resulted in successful reduction of the tumour. Ten years after the operation, there was no recurrence or metastasis.
We present a case of isolated carcinoid tumor of the sacrum and highlight the unusual nature of this lesion. The histopathology suggests hindgut cause, and we discuss the possibility of an underlying congenital tailgut cyst. We review the pathology of these rare anomalies with reference to embryological development and known instances of carcinoid focus. We also present previous reports of sacral carcinoid.
Transverse fractures of the sacrum with neurological complications have been studied in four patients illustrating the following features: diagnosis is often delayed, there are radiological difficulties in making the diagnosis, and the indications for surgery are not well defined. Specific radiographic views are recommended. All the cases presented in this report responded well to conservative management.
Death due to a chondroblastoma of the sacrum is uncommon. We report the case of a 48-year-old man with this condition. During a 10-year period, the tumor spread into the retroperitoneal space and was an enormous mass after repeated radiotherapy. The patient died of renal failure. The tumor was histologically benign even at autopsy.
Giant cell tumor (GCT) is a locally highly aggressive tumor of bone comprising 5 to 10% of all benign bone tumors. The sacrum is the third most common site of involvement. Patients with sacral GCTs present with localized pain in the lower back that may radiate to one or both lower limbs. Vague abdominal complaints and bowel and bladder symptoms may also be present. Neuroimaging workup should include advanced modalities, preferably magnetic resonance imaging, prior to obtaining a biopsy specimen. Giant cell tumor has a 1 to 5% rate of metastasizing to the lung and may convert to a fulminate malignant variant, which has a very poor prognosis. The standard treatment for GCT is curettage combined with adjuvant bone grafting or cement-augmented stabilization. In appropriately selected cases, sacral resection is a valuable procedure to effect local tumor control and overall survival. Embolization may also prove palliative and/or curative in cases in which the tumor is unresectable or refractory to treatment.
Although osteoporotic fractures of the sacrum seem to be a well-known entity, their associated rate of neurological complications has not been assessed in the literature. The authors report three such cases of nerve root compromise in elderly women and conduct a literature review. Based on their review, they estimate the incidence to be approximately 2%. The true incidence is probably higher because many case reports provide only scant information on symptoms; furthermore, sphincter dysfunction and lower-limb paresthesias are the most common symptoms and can readily be overlooked or misinterpreted in elderly patients with multiple health problems. The neurological manifestations were delayed in some cases. A full recovery is the rule. The characteristics of the sacral fracture are not consistently related with the risk of neurological compromise. In most reviewed cases the authors found no displacement and in many the foramina were not involved. The pathophysiology of the neurological manifestations remains unclear. The authors suggest that patients with sacral osteoporotic fractures should be carefully monitored for neurological manifestations.
This retrospective study examined 10 patients with osteoid osteoma and 11 patients with osteoblastoma localized in the sacrococcyx. In the sacrum, the diagnosis was delayed compared to other sites. Curettage through a posterior approach is the treatment of choice. Radiotherapy as well as embolization of feeding arteries may be used for the most aggressive lesions. Prognosis is generally good with a low incidence of local recurrence (<10%).
Three cases of nerve root compromise in elderly women with insufficiency fractures of the sacrum are reported. Neurological compromise is generally felt to be exceedingly rare in this setting. A review of 493 cases of sacral insufficiency fractures reported in the literature suggested an incidence of about 2%. The true incidence is probably higher since many case-reports provided only scant information on symptoms; furthermore, sphincter dysfunction and lower limb paresthesia were the most common symptoms and can readily be overlooked or misinterpreted in elderly patients with multiple health problems. The neurological manifestations were delayed in some cases. A full recovery was the rule. The characteristics of the sacral fracture were not consistently related with the risk of neurological compromise. In most cases there was no displacement and in many the foramina were not involved. The pathophysiology of the neurological manifestations remains unclear. We suggest that patients with sacral insufficiency fractures should be carefully monitored for neurological manifestations.
Thirty-six patients with radiopaque calculi in the segment of the ureter overlying the sacrum, were treated in the prone position with an unmodified Dornier HM-3 lithotripter. Thirty-one treatments were successful and five failed for a success rate of 86%. Success is defined as the absence of fragments on KUB. The five failures were all removed ureteroscopically. Epidural anesthesia was used for all cases. A post-extracorporeal shock wave lithotripter (post-ESWL) gastrointestinal (GI) bleeding episode, and an upper ureteral extravasation post-ESWL, as well as two patients who could not tolerate the position are discussed.
In two women aged 85 and 62 years respectively, with pain in the lower back and the hip region, insufficiency fractures of the sacrum were diagnosed. They were treated by bed rest and pain medication with good clinical outcome. Especially in older, postmenopausal women who have been treated for a malignancy (possibly with irradiation of the pelvis), the possibility of sacral insufficiency fractures should be kept in mind. Many unnecessary and sometimes invasive investigations to exclude tumour or metastases can be avoided by adequate diagnostic imaging: first conventional X-ray investigation followed by skeletal scintigraphy. A typical H-shaped pattern of sacral uptake is diagnostic of insufficiency fractures. As this pattern is seen in only approximately 20% of the patients, additional CT will often be necessary. CT can demonstrate the fracture lines and exclude bone destruction or a soft tissue mass. In case CT is not conclusive MRI is indicated.
An unusual case of hydatid cyst of the sacrum revealed by low back pain and sciatica in a 16-year-old is reported. Computed tomography and a surgical biopsy provided the diagnosis. The outcome was favorable one year after mebendazole therapy initiation.
Axial and sagittal computed tomographic (CT) scans of 40 sacrum specimens were obtained. The measurements of the upper sacral canal and S1-2 and S2-3 anterior sacral foramina were performed on axial scans, and the evaluation of the upper sacral pedicle was based on sagittal scans. The results showed that there were statistically significant differences between male and female specimens in 3 of 29 measurements. In general, the measurements of male specimens were slightly larger than those of the female specimens, and the linear dimensions of the sacral canal, anterior foramina, and pedicle decreased from the S1 to S3. This study indicated that the critical area of the sacral pedicle for screw insertion lies in the junction between the pedicle and vertebral body. CT scans provide more accurate information about the essential sacral anatomy.
Radiological findings in a case of spinal Ewing' s sarcoma are reported. A lytic lesion with soft tissue component in the sacrum was identified. Ewing's sarcoma should be included in the differential diagnosis, especially when a child has a lytic lesion with soft tissue extension in the spine.
We report a new case of asymptomatic pneumatocyst of the sacrum in a 45-year-old man with a history of lumbago. Pneumatocysts are rare benign osseous lesions filled with gas and always found in the subchondral bone of the sacral or iliac side of the sacroiliac joint. The diagnosis is made by CT scan. In the sacral location, the pneumatocyst is asymptomatic and surgical treatment is not justified.
An extremely rare case of combined transverse and vertical fracture of sacrum with neurological deficit is reported here with a six month follow-up. The patient also had an L1 compression fracture. The patient has recovered significantly with conservative management.
Correction of adult scoliosis frequently involves long segmental fusions, but controversy still exists whether these fusions should include the sacrum. It has been suggested that forces associated with activities of daily living transfer the stresses to the remaining levels of the spine and to the pelvis. The case described here was a 43-year-old woman with scoliosis and chronic back pain refractory to non-surgical modalities. Radiographically, the patient had a 110 degree lumbar curve. An anterior and posterior fusion with Luque-Galveston instrumentation was performed. Six months postoperatively the patient returned with a 2-week history of right hip pain with no history of trauma. There was radiographic evidence of a displaced femoral neck fracture and pubic rami fractures. The femoral neck fracture was treated with a total hip replacement. Further surgeries were required to correct a lumbar pseudoarthrosis and hardware failure. We believe that this case provides evidence that fusion into the lumbosacral junction may distribute forces through the pelvic bones and hip resulting in stress and potential hardware complications, especially in patients at risk due to osteopenic conditions.
Isolated manifestation of recurrent rectal cancer in the pelvis after primary radical resection occurs in 7 to 33% and frequently causes severe sacral pain. Sacral recurrence gravely impairs the quality of life as well as life expectancy. Irradiation offers a means of palliation. However, even if radiation is effectful it only provides symptomatic recurrent tumors frequently remain radioresistant 1.4. Only portal sacral resection potentially provides curative treatment if the Recurrent tumor is limited to the sacrum. Without surgical therapy the life expectancy of patients with local recurrence of rectal cancer is about 7 months.