The sacrum is the lowest part of the spine. It has a structure that surrounds the pelvis from behind and acts as its continuation. It may sometimes be called coccyx. It is one of the most important bones that make up the pelvis.
Sacrum tumors are special tumors due to their different anatomical locations and the nerve roots they contain, their relationship with the pelvic organs and large vessels, and the subtleties in their treatment. While some of the sacrum tumors may originate from the sacrum itself, (metastatic) tumors from other regions are also frequently seen in the sacrum. Giant cell tumor, aneurysmal bone cyst, osteoid osteoma and nerve sheath tumors can be seen among benign tumors. Chordoma and sarcomas may be seen from malignant tumors.
Symptoms
Sometimes there may be only waist or leg pain, sometimes pain in the coccyx. Sometimes numbness or loss of strength in the legs may occur. Urination disorders, digestive system and defecation problems may occur. Constipation and feeling of fullness are sometimes the first symptoms observed. Sexual dysfunctions may occur. Symptoms can create very different clinical pictures depending on the location of the tumor and its spread. In addition to malignant tumors, high fever, weight loss and general findings of malignant tumors may also be observed. The patient's complaint, disease history and examination are very important for diagnosis.
Diagnosis
- Magnetic resonance imaging (MRI) is usually the first examination requested. It gives very detailed information about the tumor. In addition, the relationship of the tumor with the organs in the pelvis is evaluated.
- Sacral tomography can provide detailed information about the structures of the spinal bones and calcifications in the tumor.
- With angiography, the blood supply of the tumor tissue and its relationship with the surrounding large vessels can be seen. .
- Deterioration and melting of the sacrum bones can be seen in x-rays.
Treatment
The most important criterion determining the treatment of sacrum tumors. is the type of tumor. For this, patients usually undergo a biopsy. Treatment is decided according to the pathology result.
Radiotherapy or chemotherapy is used in the treatment of malignant tumors such as chordoma or sarcoma. Since it does not have much effect, the main treatment is to remove the tumor. The most important point here is to remove the tumor together with the healthy, tumor-free tissues around it. The nerves that control the legs and feet and the nerves that control urine and stool pass through the sacrum bone. In sacral tumors, these nerve structures are usually surrounded by tumor tissue and cannot be separated. These nerve structures may need to be cut when removing the tumor.
In benign tumors, the tumor is usually removed by entering the tumor and breaking it down. In this way, it may be possible to protect nerve structures. After the removal of the entire sacrum bone, called total sacrectomy, lumbopelvic stabilization (fixing the spine and pelvis with screws) may be necessary.
Surgical interventions for sacrum tumors carry high risks in many aspects. Total removal of the tumor is the basis of surgical treatment. However, due to the characteristics of the location and its relationship with the abdominal and pelvic organs, total sacrectomy is a very special surgery. Therefore, it is important that surgeries for sacral tumors are performed by teams experienced in sacral surgery.
Angiography and occlusion performed before surgery increases comfort during surgery and can minimize blood loss. Sometimes, it may be possible to deliver effective drugs to the tumor with this method. Although radiotherapy is used to shrink the remaining tumor after surgery and prevent recurrence, it is not effective for most malignant tumors.
Chordoma
Approximately half of all chordomas are seen in the sacrum. Additionally, chordomas are the most common tumors originating from the sacrum. These tumors, which originate from notochord remnants formed before birth, are malignant and grow slowly. They are generally more common in middle age and older people. They are twice as common in men than in women. Chordomas are among the first tumors that should come to mind in patients who complain of low back pain and constipation after the age of 40. Confirming the diagnosis by taking a biopsy before surgery helps when making a surgical plan. The treatment is done without entering the tumor itself, and with healthy non-tumorous tissues around it. It is subtracted together with r. If early diagnosis can be made, the risks and complications of the operation are much lower.
Sarcoma
Tumors such as osteosarcoma, chondrosarcoma, Ewing sarcoma cause progressive local pain and loss of strength and sensation in time. They can be seen with losses and dysfunctions. Chondrosarcomas may occur directly in the sacrum or may develop as a result of the malignancy of benign tumors such as enchondroma and osteochondroma. These are seen at an average age of 45 and are more common in men, while osteosarcomas are more common at older ages. Only Ewing sarcoma can occur in children or young adults, and their prognosis is worse than those seen outside the sacrum. This is due to delayed clinical manifestations and their ability to reach large sizes. In sarcomas located in the sacrum, it is important to confirm the diagnosis with PT/CT and biopsy before surgery. The treatment is to remove the tumor along with the intact tumor-free tissues around it, without entering the tumor.
Giant Cell Tumor
Giant cell tumors are the second most common tumors of the sacrum. Although they are generally benign, their rate of partial malignancy is not very low. It also has the ability to spread to the lungs. They are masses that grow by expanding the bone and usually reach large sizes when diagnosed. In many patients, a mass can be noticed during rectal examination. Its incidence is common between the ages of 20-40. They often present with radiating pain behind the hip. Its treatment is surgery. It is important to remove the mass completely and clean it as much as possible to prevent it from recurring. In tumors that cannot be completely removed by turning around, it is also possible to clean the inside of the tumor by curettage. In the operations of these tumors, as in all sacrum tumors, it may be necessary to place screws and fix them with the spine and pelvis bones.
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