Sacral tumors: a hidden problem

Twenty-three cases of proven primary or secondary sacral neoplasms were reviewed to summarize our experience and suggest appropriate modes of diagnosis. Twenty patients (83%) presented with symptoms indistinguishable from lumbosacral disc syndrome. There was an average delay in diagnosis from onset of symptoms of 8.2 months. Initially, 15 patients were interpreted as having normal lumbosacral spine films; however, in review, 12 of these studies did show subtle changes.Computerized tomography was performed in eight patients; seven showed abnormalities. Radionuclide scans were initially positive in 11 of 15 patients. Other roentgenographic procedures were less useful. Overlying bowel gas, sacral anatomy, and inability to detect moderate demineralization hinders earlier diagnosis. A high degree of suspicion and knowledge of the difficulty of diagnosis is needed for sacral tumors. Evaluation should be complete and correlated with clinical history. If all studies are negative, they should be repeated at frequent intervals.