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A case is reported of a giant cell tumour of the sacrum, an infrequent but well-recorded site for this tumour. The relatively benign histology of this neoplasm was not consistent with its natural history in this patient, nor with its resistance to treatment. An additional feature of interest and concern was the intense vascularity of the lesion.
A rare case of primary malignant GCT of sacrum in a 35-year-old female is reported.
The authors describe the method used to reconstruct the posterior wall of the pelvis using a flap taken from the rectus abdominis muscle after resection of the sacrum to treat neoplasm.
We describe the diagnosis and surgical management of fibrosarcoma of the sacrum in a pediatric patient. We retrospectively reviewed the literature and a case report. Total sacrectomy is a viable treatment option in the management of large malignant sacral tumors. The techniques used in adult patients can be extended to and improved upon for pediatric patients. The input of multiple surgical specialties is essential in the management of these lesions.
A case of giant cells tumor of the sacrum, invading a large part of the sacral body, the buttock is reported. The sacro-rectal space and the sacral canal with the cauda equina were compressed. Complete avulsion was performed, each nerve being closely dissected. Clinical recovery with roentgenographic aspect of bone healing is still present, three years and a half post-operatively.
A care of the patient, aged 39, who sustained a fracture of the sacrum complicated by compression of the roots L5 and S1 is reported. Surgical treatment on root decompression was performed. Following 9 months neurological signs subsided, but some intermittent low back pain persisted.
OBJECTIVE: To investigate the way of resection of high-sacrum tumors and the way and duration of the spinal-pelvic TSRH or ISOLA internal fixation. METHOD: From October 1998 through April 2002, 35 patients with sacral tumor were enrolled in our hospital, including 4 cases in L(5)-S(1), 2 in L(5)-S(2), 4 in S(1), 8 in S(1 - 2), 6 in S(1 - 3), 6 in S(1 - 4), 5 in S(1 - 5). 35 patients were followed by lumbo-pelvic TSRH or ISOLA internal fixation and corresponding chemotherapy and radiotherapy. RESULTS: In the follow-up period of 6 - 42 months, the short-term results were satisfactory with the lumbosacral pain reduced and the neurological function improved in different degrees, however dysuria occurred in 1 case and skin necrobiosis at coccygeal incision occurred in 1 case; two cases experienced cerebrospinal fluid leakage and 1 case experienced postoperative infection and delayed healing, 1 case with chordoma and 2 cases with malignant fibrous histiocytoma recurred 1 year after postoperation, one of these 2 cases with malignant fibrous histiocytoma suffered from lung metastasis and died of system failure 19 months after postoperation. No fractured rod occurred. CONCLUSION: Surgical procedure and postoperative comprehensive treatment have important effects on the prognosis. High-sacral tumor resection and reconstruction are effective means of achieving stabilization, providing significant pain relief and preserving ambulatory capacity.
A new method of internal stabilization of transforaminal sacrum fractures in unstable pelvic ring fractures was developed by modification of standard AO small-fragment implants. The rationale of this type of stabilization is the use of an unilateral dorsal approach and avoidance of transfixation of the uninvolved SI joints. In a comparative biomechanical study on 8 human cadaver pelvises two types of the new type of stabilization were compared to stabilization with Harrington sacral bars and transiliosacral screw fixation. The fracture model represented a Tile C1 type injury (symphysis disruption and transforaminal sacral osteotomy) on a complete pelvic ring. The anterior stabilization was performed with a 4-hole AO 4.5 mm DC plate in all cases. The load simulation used a one-leg standing model in an upright position with abductor muscle simulation. The pelvises were loaded in 4 load stages of 50%, 80%, 100% and 130% body weight. In each load stage 4 load-unload cycles were completed. With a three-dimensional measurement system (Polhemus 3 Space Motion Tracker) translations an rotations in the fracture plane could be analyzed. Typical behavior in the load-displacement curve was seen in all implants, with settling during the first cycles and permanent displacement after exceeding a specific failure load. The failure load showed no significant differences between implants (99.6-113.6% body weight). The analyses of the persistent displacement, the elasticity and the direction of displacement and rotation showed a typical behavior in the implants, but no differences, which can be interpreted as a significant difference in the stability of the fixation methods. In an additional test the new fixation method showed no loosening in 10,000 cycle loading with 60% body weight. The new stabilization method showed biomechanical results comparable to clinically successful methods of stabilization in the chosen fracture model. Thus, clinical applications of this type of stabilization may be successful.
Giant Cell Tumours (GCT) of the Bone is one of the commoner primary bone tumours. Although considered a benign tumour, it does occasionally metastasize to the lungs. Treatment modalities vary according to the surgical staging and the site of the tumour. Treatment is further complicated when the tumour occurs in difficult locations like the sacrum. The paper includes a review of literature into treatment options and the presentation of 3 patients with sacral GCTs, one of which also has multiple pulmonary metastases from a "benign" giant cell tumour.
OBJECTIVE: Presentation of a new triangular osteosynthesis technique that permits early weight-bearing in vertically unstable sacral fractures. DESIGN: : Retrospective evaluation of a consecutive series. SETTING: Level I trauma center. PATIENTS: Thirty-four patients, twenty-eight of whom were poly-traumatized, all with vertically unstable sacral fractures. This group included eight women and twenty-six men, with a mean age of thirty-five years. Average time between trauma and definite operation was thirteen days (range 0 to 28 days). INTERVENTIONS: All patients underwent triangular osteosynthesis using a combination of a vertical vertebro-pelvic distraction osteosynthesis (pedicle screw system) and a transverse fixation of the sacrum fracture with either iliosacral screws or trans-sacral plating. Immediate postoperative weight-bearing was permitted postoperatively. RESULTS: Nineteen patients were treated with early progressive weight-bearing and advanced to full weight-bearing, on average, after twenty-three days (range 8 to 70 days). Three of the thirty-four patients (9 percent) experienced loosening of hardware, including two patients (6 percent) who required secondary intervention because of loss of the original reduction. Further complications included one pulmonary embolism (3 percent), one iatrogenic nerve lesion (3 percent), one wound necrosis (3 percent), and two local infections (6 percent). CONCLUSIONS: Triangular osteosynthesis is a demanding procedure that can be performed on vertically unstable sacral fractures to allow early progressive weight-bearing with an acceptable complication rate.
A 54 year old, postmenopause female with pulmonary fibrosis on steroid therapy is studied for lumbar and sacral pain. An insufficiency fracture of the sacrum is found. Bone scintigraphy and CT scan of the area made the diagnosis. Clinical and laboratory findings are submitted together with a literature review.
Six cases of insufficiency fracture of the sacrum were diagnosed in the Rheumatic Diseases Division of the CHUV during 1990. They show that this recently described entity is frequent. Present knowledge of the clinical course, predisposing factors, radiological findings and treatment is reviewed. This diagnosis should be considered in all cases of lower back pain occurring in postmenopausal women. Awareness of this entity should make it possible to avoid unnecessary invasive investigations.
The authors describe a semiconservative approach for bilateral fracture-dislocation of the sacrum, an extremely rare injury. Traction is advocated; it seems to lead to a good functional result after 20 years. Other authors either propose internal fixation or benign neglect, also with a good outcome. Every case must be approached on an individual base.
The prognosis of giant cell tumors arising in the sacrum is difficult to ascertain. Because of the low incidence in Japan there are scanty statistics. We selected 14 cases from the Bone Tumor Registry in Japan. Questionnaires were sent to hospitals which had submitted cases, regarding Enneking's staging, surgical approach, surgical procedure, radiotherapy, chemotherapy, complications and prognosis of this tumor. The results of the questionnaire show that surgery alone gives better results than combined surgery and radiotherapy. Good prognosis called for surgery alone. Curettage resulted in no evidence of disease (NED) in four cases. Bad prognosis called for combined surgery, radiotherapy and chemotherapy. If we surmise from the biological behavior of the giant cell tumor, that the tumor mass extends out extraosseously en-bloc excision with nerve roots is indicated. Extensive curettage will be adequate if the tumor is confined intraosseously. Radiotherapy should not be selected except for inoperative cases.
We report a case of an adult male with neurofibromatosis and chronic low back pain. Evaluation revealed an anterior sacral meningocele, pulmonary tuberculosis, and later in the course of his illness, an osteolytic tuberculous mass in the sacrum. The patient was treated medically with a good outcome. The nature of anterior sacral meningoceles and tuberculosis spondylitis, the differential diagnoses, and relevant treatment options are discussed.
The most common primary tumors of the sacrum are chondrosarcoma, and giant cell tumors. These tumors can display a great development at the time of first examination on account of their slow growth, delayed expression of pelvic organs compression and metastases. The spontaneous long lasting evolution of sacral primary tumors is disastrous with neurological involvement, painful visceral complications and a high incidence of lethal evolution. Local control and cure of these tumors is possible only if radical resection is done regardless to neurological sequelae. The author proposes a surgical procedure for a carcinologic resection using two different anterior and posterior approaches in one stage with two teams. Six patients were treated in this way and the follow-up ranges from 5 to 11 years. One patient died two years post-operatively (malignant teratoma); the others survive: 2 chordomas (11 and 5 years post-op.), 2 chondrosarcomas (8 and 6 years pos-op.) and 1 giant cell tumor (6 years post-op.). These results with prolonged survival without recurrence justify our proposal of an aggressive surgical approach to treat these malignant tumors.
We report a patient with a stress fracture in the sacrum. This may be a cause of hip or back pain. In contrast to typically bilateral insufficiency fractures, fatigue fractures are usually unilateral and the appearances are not diagnostic on scintigraphy. As the plain film findings may be subtle and overlooked, computed tomography is more specific in delineating a sclerotic vertical fracture parallel to the sacroiliac joint. Recognition of the characteristic radiographic pattern in sacral fatigue fractures can avoid incorrect diagnosis and unnecessary tests or treatment.
We report ten cases of insufficiency fracture of the sacrum, a recently individualized pathological entity. These fractures occur in elderly women with pronounced osteopenia of the pelvis. The clinical symptoms are low back pain and sometimes mechanical radiculalgia. Histories of previous injury are rare. In 50 per cent of the cases X-ray films of the pelvis show fractures of the anterior pelvic arch (iliopubic and ischiopubic rami). Computerized tomography or radionuclide bone scanning provide an almost certain diagnosis of sacral insufficiency fracture. This diagnosis is confirmed by a favorable clinical outcome after 2 months.