Chordoma of the Sacrum - A Case Report of Enbloc High Sacrectomy and Review of Literature

Abstract

“Coccydynia” unresponsive to a trial of conservative treatment should be evaluated promptly. Otherwise we may be fraught with the danger of serious complications. Sacral tumors are often quiescent to start with. They may achieve enormous size before they become symptomatic. Here is a case report and literature review of such a case in a 63 year old male, which was initially treated as coccydynia, till he became severely symptomatic. Chordomas are the most common primary tumor of the sacrum in adults. They are locally aggressive with immense potential for local recurrence and metastasis to lungs and other bones. If they get to the right hands at the right time, they are mostly curable. Total sacrectomy (Enbloc resection) is the treatment of choice for sacral chordomas. In early stages, a low sacral resection all from behind is possible. Lesions extending higher than S3 requires high sacrectomy and lumbopelvic fixation depending on the integrity of the sacroiliac joints. High sacrectomy has high morbidity of permanent colostomy and bladder catheterization.A 63 year old man presented with coccydynia of long duration and was diagnosed as chordoma of the sacrum upon imaging and image guided biopsy. He was treated with anterior, posterior and anterior surgeries in a single sitting, through a multi disciplinary approach.