OBJECTIVE: To observe the efficacy and complications of one-stage tumor resection to treat primary sacral neurogenic tumors and to discuss some details in the clinically relevant anatomy. METHODS: A retrospective analysis of 26 patients with neurogenic turors of the sacral spine who were surgically treated from January 2001 to January 2018, including 16 males and 10 females, aged from 21 to 69 years old with an average age of (39.3±10.9) years old. The courses of diseases ranged from 3 to 56 months with an average of (17.9±10.1) months. The diameters of presacral components ranged from 3.3 to 19.6 cm with an average of (8.7±4.1) cm. The proximal margin of presacral lesions was above the L₅S₁ level in 6 cases, and lower than L₅S₁ in 20 cases. A posterior incision approach for one-stage complete resection of the tumor was used firstly, and an anterior approach was combined when necessary. Spinal-pelvic reconstruction with the modified Galveston technique was also carried out in relevant cases. Whether to preserve the tumor-involved nerve roots depended on the situation during the operation. The operation time, intraoperative blood loss, pain relief, and complications were recorded. The lumbosacral spine stability and sacral plexus neurological function were evaluated during postoperative follow-up, and local recurrence and distant metastasis were examined as well. RESULTS: Total excision was achieved in all 26 patients, with an operation time of (160.4±35.3) mins and an intraoperative blood loss of (1 092.3±568.8) ml. Tumors have been removed via a posterior-only approach in 21 cases and via combined anterior/posterior approaches in 5 cases. The diameter of presacral masses components ranged from 11.3 to 19.6 cm with an average of (15.1±3.2) cm in patients with combined anterior/posterior approaches, and ranged from 3.3 to 10.9 cm with an average of (7.2±2.4) cm in patients with a posterior-only approach. Five of the six patients whose proximal margin of presacral masses was above the L₅S₁ level adopted combined anterior/posterior approaches, and 20 patients lower than the L₅S₁ level adopted the posterior-only approach. All the patients were followed up for 6 to 82 months with an average of(45.4±18.2)months. Postoperative lumbosacral pain and lower extremity radicular pain were significantly relieved, and sensation, muscle strength and bowel and bladder function were also improved to varying degrees. The postoperative early complications included superficial wound infection in 1 case and cerebrospinal fluid leakage in 2 cases. Pathology confirmed 17 cases of schwannoma, 7 cases of neurofibroma and 2 cases of malignant schwannoma. Local recurrence was observed in two cases of benign neurogenic tumors. One patient with a malignant nerve sheath tumor had lung metastasis, who died 20 months after the operation. In 17 cases of upper sacral neurogenic tumors, 4 cases did not undergo spinal-pelvic reconstruction with internal fixation, of which 2 cases suffered from postoperative segmental instability. Tumor-involved nerve roots were resected during surgery in 7 cases. One of these patients who had S₂ and S₃ nerve roots sacrificed simultaneously had an impaired bladder and bowel function postoperatively, and did not recover completely. In the other 6 cases, the neurological function was not damaged obviously or recovered well. CONCLUSION The posterior approach can directly expose the lesions, and it is also convenient to deal with nerve roots and blood vessels. The operation time, intraoperative blood loss, degree of symptom relief, complication rate, and recurrence and metastasis rate can be controlled at an appropriate level. It is a safe and effective surgical approach. When the upper edge of the presacral mass is higher than the L₅S₁ level or the diameter of the presacral mass exceeds 10 cm, an additional anterior approach should be considered. The stress between the spine and pelvis is high, and internal fixation should be used to restore the mechanical continuity of the spine and pelvis during resection of neurogenic tumors of the high sacral spine. Most of the parent nerve roots have lost their function. Resection of a single parent nerve root is unlikely to cause severe neurological dysfunction, while the adjacent nerve roots have compensatory functions and should be preserved as much as possible during surgery.
Adult ; Aged ; Blood Loss, Surgical ; Female ; Humans ; Male ; Middle Aged ; Pain/pathology* ; Postoperative Complications/pathology* ; Retrospective Studies ; Sacrum/surgery* ; Treatment Outcome ; Young Adult

Arachnoiditis ; diagnosis ; diagnostic imaging ; pathology ; Humans ; Lumbar Vertebrae ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography ; Sacrum ; diagnostic imaging ; pathology

Adolescent ; Adult ; Arteries ; Bone Cysts, Aneurysmal ; therapy ; Child ; Embolization, Therapeutic ; Female ; Humans ; Male ; Sacrum ; pathology ; Spinal Diseases ; therapy ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the clinical features and prognosis of bone metastases in colorectal cancer patients.

METHODSThe clinical data of 104 cases of colorectal cancer with bone metastasis were collected and retrospectively analyzed.

RESULTSAmong all the 104 patients included, 45 (43.3%) patients had multiple bone metastases, and 59 (56.7%) patients had single bone metastasis. Pelvis (46.1%) was the most common site, followed by thoracic vertebrae (41.3%), lumbar vertebrae (40.4%), sacral vertebrae (29.8%) and ribs (29.8%). One hundred and two patients (98.1%) were complicated with other organ metastases. The median time from colorectal cancer diagnosis to bone metastasis was 16 months, and the median time from bone metastasis to first skeletal-related events (SREs) was 1 month. The most common skeletal-related events (SREs) were the need for radiotherapy (44.2%), severe bone pain (15.4%) and pathologic fracture (9.6%). The median survival time of patients with bone metastases was 10.0 months, and 8.5 months for patients with SREs. ECOG score, systemic chemotherapy and bisphosphonate therapy were prognostic factors by univariate analysis (all P < 0.05). ECOG score and systemic chemotherapy were independent prognostic factors by Cox multivariate analysis.

CONCLUSIONSBone metastasis in colorectal cancer patients has a poor prognosis and the use of chemotherapy and bisphosphonates may have a benefit for their survival.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bone Density Conservation Agents ; therapeutic use ; Bone Neoplasms ; drug therapy ; radiotherapy ; secondary ; Colorectal Neoplasms ; drug therapy ; pathology ; radiotherapy ; surgery ; Diphosphonates ; therapeutic use ; Female ; Follow-Up Studies ; Fractures, Bone ; etiology ; Humans ; Lumbar Vertebrae ; pathology ; Male ; Middle Aged ; Pain ; etiology ; Pelvic Bones ; pathology ; Prognosis ; Retrospective Studies ; Ribs ; pathology ; Sacrum ; pathology ; Spinal Cord Compression ; etiology ; Spinal Neoplasms ; drug therapy ; radiotherapy ; secondary ; Thoracic Vertebrae ; pathology ; Young Adult

Adolescent ; Female ; Humans ; Sacrum ; pathology ; surgery ; Spondylolysis ; diagnosis ; pathology ; surgery

OBJECTIVETo analyze the radiogenic distribution in the sacrum in whole-body bone scanning.

METHODSA total of 212 patients receiving whole-body bone scanning without any explicit bone metastases were divided into different age and gender groups. The radioactive distribution in the sacrum in whole-body bone scanning was analyzed statistically.

RESULTSOf these cases, 31.1% presented with thin radioactive distribution in the sacrum and 11.3% exhibited increased radioactive distribution. Normal radioactive distribution in the sacrum was found in 57.6% of the cases. In both male and female elderly patients (>70 years), the rate of normal radioactive distribution in the sacrum was obviously reduced with increased rate of thin radioactive distribution. The female elderly patients showed higher rate of increased radioactive distribution in the sacrum than male elderly patients.

CONCLUSIONThe radioactive distribution in the sacrum is similar between female and male patients. Elderly male patients over 70 years have generally thin radioactive distribution in the sacrum due to the presence of osteoporosis, which is also associated with latent fracture of the sacrum to result in increased radioactive distribution in the sacrum in whole-body bone scanning.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Neoplasms ; diagnostic imaging ; pathology ; Radionuclide Imaging ; Sacrum ; diagnostic imaging ; Spinal Neoplasms ; diagnostic imaging ; secondary ; Technetium Tc 99m Medronate ; pharmacokinetics ; Whole Body Imaging ; Young Adult

OBJECTIVESTo review the patients with malignant pelvic tumors involving sacrum treated surgically and to discuss the methods of resection of tumors and reconstruction of defects.

METHODSNineteen patients with malignant pelvic tumors involving the sacrum were treated surgically in People's Hospital between July 1999 and July 2007. The series comprised 12 males and 7 females. Five patients were diagnosed with chondrosarcoma, 4 with Ewing sarcoma, 4 with osteosarcoma, 1 with malignant fibrohistiocytoma (MFH), 1 with giant cell tumor (GCT), and 4 with metastatic bone tumors. Acetabulum was preserved after resection of the iliac and sacral tumor and reconstructed with screw and rod system in 10 patients. Among this 10 patients, 5 of them were also done bone graft. Acetabulum was not preserved after resection of the iliac and sacral tumor and the defect was reconstructed with modular hemipelvic prosthesis in 9 patients.

RESULTSOncology result: 7 patients (7/19, 36.9%) had local relapse, including of 2 osteosarcoma, 2 chondrosarcoma, 2 Ewing sarcoma and 1 metastatic tumor. Two of 4 osteosarcoma, 2 of 4 Ewing sarcoma, 1 of 5 chondrosarcoma and 1 MFH patients died of lung metastasis. Two patients with metastatic lung cancer died of the disease 1 year after surgery. One patient with kidney carcinoma and 1 with thyroid carcinoma alive without of disease. Functional result: 8 patients with acetabular reconstruction after resection of pelvic and sacral tumors could walk with a cane 2 months after surgery. Average ISOLS function score was 20, including good in 3, fair in 5 and poor in 1 patient. One of the patient with modular hemipelvic prosthetic reconstruction occurred dislocation treated with 1 month after surgery and experienced open reduction. Hemipelvic prosthesis was took out in 1 patient because of the deep infection.

CONCLUSIONSFor patients with acetabulum preserved after resection of the iliac and sacral tumor, reconstructed with screw and rod system combining with bone graft is an ideal method for restoration. Bone graft with resected femoral head and neck on residual sacrum and modular hemipelvic prosthetic reconstruction after resection of the pelvic tumor involving of the secrum is a good choose.

Adolescent ; Adult ; Aged ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Orthopedic Procedures ; Pelvic Bones ; surgery ; Pelvic Neoplasms ; pathology ; surgery ; Retrospective Studies ; Sacrum ; pathology ; surgery ; Young Adult

OBJECTIVETo evaluate curative effect of the fibrinogen gel for treating sacral canal arachnoid cyst.

METHODSNineteen patients with sacral canal arachnoid cysts included 7 males and 12 females; The average age was 48.4 years ranging from 19 to 68 years. The course was from 2 weeks to 7 months. Of all the patients, 9 were in level of S1, 4 were in level of S1 to S2, 5 were in level of S2, 1 was in level of S1 to S3. Cystis wall greater partial excision adopted in 11 cases, partial resection in 8, then all patients were treated by spray painting fibrinogen gel.

RESULTSNineteen patients were followed-up for 13 to 30 months (mean 21.3 months). The clinical symptom disappeared completely in 18 patients, and only one patient urinated incapably, but after 2 weeks returned to normal. No one found recurrence by MRI after 12 months.

CONCLUSIONThis method of fibrinogen gel for treating sacral canal arachnoid cyst has advantages of easy performing, safety, achieve good results, less neck symptoms and early commencing of mobilization.

Adult ; Aged ; Arachnoid Cysts ; pathology ; therapy ; Female ; Fibrinogen ; administration & dosage ; Gels ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Sacrum

Intraspinal bronchogenic cysts are rare congenital cystic lesions. In all the reported cases, the cysts have been located in the cervical, upper thoracic or thoracolumbar segments. We report the case of an intraspinal bronchogenic cyst in the sacral location. We present the case of a 5-month-old female with a skin dimple in the midline over the sacral vertebra. Magnetic resonance image of the lumbar and sacral vertebra revealed a dermal sinus tract and an epidural cystic mass at the S2 level. The patient underwent the removal of the dermal sinus tract and the cyst. The cystic mass was shown to be connected to the subarachnoid space through a slender pedicle from the dura. The cyst was diagnosed to be a bronchogenic cyst based on the results of the histopathological examination. We conclude that intraspinal bronchogenic cysts may appear in the sacral location.
Bronchogenic Cyst/diagnosis/pathology/*surgery ; Epithelium/pathology/*surgery ; Female ; Humans ; Infant ; Lumbar Vertebrae/pathology ; Magnetic Resonance Imaging/methods ; Sacrum/pathology ; Spinal Dysraphism/complications ; Treatment Outcome

OBJECTIVETo discuss the surgical methods and effects in the treatment of sacrum tumor.

METHODSFifteen patients of sacrum tumor included 12 males 3 females aged from 17 to 68 years old,mean 54.6 years. Ten cases were primary tumor and 5 were metastatic tumor. Five cases underwent anterior approach tumor extirpation, 3 posterior approach tumor extirpation and 7 posterior tumor extirpation with bone graft and internal fixation of a pedicle screw and rod system. Additionally, all cases were treated with radiotherapy or/and chemotherapy post-operatively according to the character of the tumor.

RESULTSThirteen patients were followed-up for 4 months to 5 years. One patient had exacerbation accompanying dysfunction of urinary and feca after surgery, which relieved after four months of non-operative treatments. One chordoblastoma and 2 metastatic tumor died of recurrence and metastasis 1 to 2 years after operation, respectively. And in another case of giant cell tumor occurred the local recurrence 6 months after operation, who refused secondary surgical treatment.

CONCLUSIONIndividualized surgical treatment with conbination of radio therapy or/and chemotherapy will make good results for patients with sacrum tumor.

Adult ; Aged ; Bone Neoplasms ; pathology ; prevention & control ; surgery ; therapy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Recurrence ; Sacrum ; pathology ; Treatment Outcome ; Young Adult