Utilization of pedicle screw and rod reconstruction system for treating sacral-lumbar defect after excision of sacral chordoma: a case report

Introduction: Sacral chordoma is a malignant lesion that is hard to treat and almost always presents with patient’s significant disability associated with neurological disturbance. The aim of treatment is often to remove the tumor as much as possible while maintaining healthy tissue as many as one’s can. A usage of pedicle-rod system is still debatable for filling the stability after the excision of the sacrum. Methods: We present a case of a 41-year-old patient came with chief complaint of pain on the buttock for quite a long time. On examination, there was a hard-palpable mass on the buttock area which causing pain on palpation. Patient was bedridden due to pain and loss of motoric function. We did a sacral-lumbotomy on this patient, definitely eliminating the whole sacrum and vertebrae L5. Afterwards, we construct the defect by using a pedicle-rod system hoping to maintain the stability. Results: The tumor was successfully removed, together with some sacral nerve plexus and roots of lumbar nerve. After the surgery, the pain improved; however, the patient had defecation and urinal incontinence. Conclusion: Utilization of pedicle screw that may provide stability is much needed. The patient may at least sit up straight after the surgery if the stability is achieved.