Sacral nerve preservation on total sacrectomy of a large atypical sacral chordoma resection: A case report

Chordoma is a slow growing benign cartilaginous neoplasm. It is rarely found in the spine, comprising only 3 % of all Chordomas. Although Chordoma is typically asymptomatic, the mass effect of the lesion on the spinal cord or nerve roots might result in a progressing neurological loss.

A 39-year-old male patient presented with pain and a mass on the buttock. The patient complained of intermittent pain for three years before hospital admission. The mass was slowly growing from the size of a marble to the size of a ping-pong ball. The patient also complained of difficulty having bowel movements, bladder and erectile dysfunction for the last 5 months. The biopsy test results in a Chordoma at regio gluteus which gave an impression of a Chordoma arising from the sacral region. Huge Sacral chrodoma was planned to be managed with total resection. Right L5 injury occurred during the surgery. The patient was stabilized with lumbopelvic stabilization. The patient could walk with minimal pain and did not show any disturbance in urination and defecation.

The mass was then excised with no intraoperative complication. At follow-up, the patient was asymptomatic and neurologically intact. Lumbopelvic stabilization can be indicated as an option for stabilization post total sacral resection because patient can have early mobilization.

In this case shown that even with large mass excision and lumbopelvic stabilization surgery with sacral nerve preservation and show a good clinical and functional outcome.