Current concepts and an update on the surgical management of metastasis to the sacral spine

Abstract

This review article endeavors to provide an update on the current concepts pertaining to the presentation, investigation, and management of sacral metastases. A review of the English language literature from 1995 to 2015 was undertaken. PubMed electronic database, SCOPUS, EMBASE, Medline OVID, and Cochrane database were searched to identify relevant studies using the terms “sacral metastases” and “metastatic sacral tumours.” Sacral metastasis can present in a variety of ways. Pain in the sacral region can be associated with neurology and mechanical instability. Multidisciplinary involvement is crucial to thoroughly work up the patient. This involves a variety of imaging modalities. Radiotherapy is often used as the first-line treatment. Surgical intervention is based on tumor location, infiltration of surrounding structures, expected outcomes based on primary malignancy, and pelvic stability. Adjuvant cryosurgery and radiosurgery have demonstrated promising results. This is a challenging entity to appropriately diagnose and treat. An appreciation of the disease stage, the clinical burden, and the implications for the individual patient are necessary to deliver patient-centered care.