DIAGNOSIS AND MANAGEMENT OF SACRAL BONE-TUMORS

Objective: To evaluate the efficacy of current treatment in patients w ith sacral bone tumours. Design: Retrospective case series. Setting: A quaternary care unit within a teaching hospital. Patients: Twenty-nin e patients with sacral tumours referred to the unit between 1983 and 1 991. Follow-up was a minimum of 18 months. Interventions: Diagnostic b iopsy in all patients. Plain radiography, ultrasonography, computed to mography (CT), magnetic resonance imaging (MRI) and bone scanning. Sac ral resection in patients with malignant or aggressive primary bone tu mours. Main Outcome Measures: The accuracy of biopsy and local and sys temic recurrence of the disease. Results: Symptoms were present for a mean of 12 months to the time of presentation. Low-back pain was prese nt in 28 of 29 patients. Radicular pain and sacral nerve dysfunction w ere found more often in patients with malignant tumours. Only three pa tients had altered bowel habits. On rectal examination a mass was palp able in 61% of patients. The sacral abnormality was demonstrated by pl ain radiography in 6 of 9 cases, by ultrasonography in 2 of 7 cases, b y bone scanning in all of 17 cases, by CT in 24 of 25 cases and by MRI in 17 of 18 cases. Fine-needle aspiration biopsy provided the correct diagnosis in only one of four patients. Transrectal biopsy resulted i n tethering of the rectum to the tumour in two patients. Core needle b iopsy gave an accurate diagnosis in eight of nine patients. Open biops y was repeated to obtain adequate tissue in 3 of 19 patients. Ten of t he 29 patients underwent only a diagnostic procedure, 5 underwent post erior resection alone and 14 underwent a combined anterior and posteri or resection of the sacrum. One of the last group died in the early po stoperative period. Two patients in whom the margins of resection were positive had local recurrence. Conclusions: Treatment of sacral bone tumours is based on the natural history of the particular bony lesion. Early diagnosis is helpful in definitive surgical management and woul d be facilitated by rectal examination and bone scanning in patients w ith persistent low-back pain.