The Journal of Bone and Joint Surgery, Vol 75, Issue 10 1476-1484, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Operative treatment of sacrococcygeal chordoma. A review of twenty-one cases
IR Samson, DS Springfield, HD Suit and HJ Mankin
Orthopaedic Oncology Unit, Massachusetts General Hospital, Boston 02114.
Between 1972 and 1992, twenty-one patients had a primary operation for the
treatment of a sacrococcygeal chordoma; seventeen had had a diagnostic
biopsy elsewhere. The average age at the time of the operation was
fifty-five years (range, six to seventy-eight years); fourteen patients
were male and seven were female. In all patients, a posterior approach was
used, even for resections at the cephalic levels of the sacrum. In
addition, sixteen of the twenty-one patients were treated with adjuvant
radiation therapy. Four patients died; three died of metastatic chordoma.
Of the remaining seventeen patients, fifteen were apparently free of
disease and had not had a local recurrence at the time of the latest
follow-up examination. The average duration of follow-up for these fifteen
patients was four and one-half years. Of the nine patients who were
followed for at least five years, seven were disease-free at the latest
follow-up evaluation. Of the seven patients in whom both second sacral
roots were the most caudad nerve-roots spared, four had normal bladder
control and five had normal bowel control. Of the four patients in whom the
most caudad nerve-roots spared were the first sacral or more cephalic
roots, all had impaired bladder control, one had impaired bowel control,
and three had a colostomy.
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