Management of massive sacral chordoma: a rare and complex surgical challenge

A woman in her 50s presented with progressively worsening low back pain, urinary incontinence and lower limb numbness. Her symptoms had gradually intensified over 1 month, severely affecting her mobility and daily activities. Neurological examination revealed significant motor weakness in the lower limbs, sensory deficits below the S1 dermatome, and bladder incontinence, raising concerns about a possible space-occupying lesion compressing the sacral nerve roots. MRI of the lumbosacral spine showed a large sacral lesion extending from S1 to S4, which was confirmed by biopsy to be a sacral chordoma. Given the size and location of the tumour, a multidisciplinary team planned a two-stage surgical approach involving both anterior and posterior resection. The anterior approach focused on isolating and mobilising the tumour from surrounding structures, while the posterior approach was used for en bloc resection and lumbopelvic reconstruction. Postoperatively, the patient achieved independent ambulation but required long-term urinary catheterisation and colostomy care. This case highlights the complex nature of sacral chordomas, the necessity for a combined surgical approach and the importance of postoperative rehabilitation in optimising patient outcomes.