Abstract
ObjectiveThis study intends to retrospectively analyze the data of patients with sacral metastases in our center, and analyze the treatment methods and therapeutic effects of sacral metastases.Methods73 patients with sacral metastases treated in our hospital from June 2013 to June 2019 were retrospectively analyzed. There were 54 cases of neurological symptoms, 42 cases of sacroiliac joint instability, 24 cases of lower limb muscle weakness and 19 cases of abnormal urination and defecation. Four patients with tumors below S3 underwent complete tumor resection, 23 patients with tumors above S3 and without sacroiliac joint instability underwent tumor curettage and nerve root lysis, 34 patients with tumors above S3 and sacroiliac joint instability underwent tumor curettage, nerve root release and screw rod reconstruction. 12 patients with multiple metastases underwent percutaneous radiofrequency ablation and sacroplasty. VAS was used to evaluate the preoperative and postoperative pain scores, and the postoperative pain relief, neurological function, bowel function, wound healing and complications were evaluated.ResultsThere were no perioperative death, 8 cases of poor wound healing, 5 cases of nerve injury, postoperative sensory and motor loss of lower limbs. Cerebrospinal fluid (CSF) leak in 7 cases. The patients were followed up for 6-25 months (mean 12 months). The VAS scores of patients with pain symptoms were 7 points before operation and 1.44 points after operation, In 19 patients with abnormal urination and defecation function, 12 patients recovered to normal 3-6 months after operation, 5 cases had no significant change compared with preoperative, and 2 cases had aggravated symptoms; 17 cases of patients with lower limb muscle strength were significantly recovered after operation, and the average muscle strength was increased by 2 grades; 30 cases of patients with unstable sacroiliac joint got internal fixation had significantly pain relief. Pain symptoms of 9 patients were significantly relieved after percutaneous radiofrequency ablation.Conclusionthe operation of sacral metastases mainly adopts a relatively conservative surgical method, which can effectively improve the quality of life of patients with sacral metastases by retaining the nerve function and relieving the pain of patients, combining with radiofrequency ablation, sacroplasty and targeted drugs.
Highlights
With the development of tumor treatment, many solid tumor patients can get effective treatment and obtain long-term survival
Radiotherapy can alleviate the symptoms of patients with sacral metastases, and has some limitations
Sacral metastases are common tumors of the sacrum, but due to the existence of systemic diseases, the treatment of this metastatic site does not have a decisive impact on the overall survival time of patients
Summary
With the development of tumor treatment, many solid tumor patients can get effective treatment and obtain long-term survival. Sacrum is the site of bone metastases in tumor patients [2, 3]. Because of the special anatomical position and abundant blood supply of sacrum [4], the treatment of sacral metastatic tumors is relatively difficult. There is no unified standard and guideline for the treatment of sacral metastatic tumors in the world. Most of the traditional treatments for sacral metastases are local radiotherapy or palliative treatment [2, 5]. Radiotherapy can alleviate the symptoms of patients with sacral metastases, and has some limitations. The treatment and complications of sacral metastases are still not very clear
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