Prevalence of neuropathic pain after radical sacral chordoma resection: an observational cohort study with 10-year follow-up

  • Rapin Phimolsarnti
  • Saranatra WaikakulEmail author
Original Article


This study was carried out to discover the prevalence, characteristics and severity of neuropathic pain after wide resection of chordoma of the sacrum by the use of posterior approach. Patients who had chordoma of their sacrums and underwent wide resection via posterior approach, during 1990–2002, were followed up as a prospective cohort. Pain assessment was carried out in terms of onset, characteristics, intensity (numerical rating scale), response to pain medication and associated symptoms. The correlation between patients’ biographic data, preoperative neuropathic pain, type and levels of surgery and pain were analyzed. There were 21 patients; 14 male and 7 female patients. Their ages ranged between 29 and 75 years. Subtotal sacrectomy was carried out in 9 patients and total sacrectomy was carried out in 12 patients. All patients survived the operation. Neuropathic pain was found in 11 patients (52.4 %). Male patients and presentation of preoperative neuropathic pain were significantly related to postoperative neuropathic pain. The other factors were not related to the postoperative pain. Recurrent of severe pain with different characteristics after the operation might indicate tumor recurrent. Early detection of the pain and proper treatment could minimize pain intensity and improved pain management satisfaction.


Sacrectomy Pain Neuropathic pain Amputation 


Conflict of interest



  1. 1.
    Fourney DR, Gokaslan ZL (2003) Current management of sacral chordoma. Neurosurg Focus 15:E9PubMedCrossRefGoogle Scholar
  2. 2.
    Zileli M, Hoscoskun C, Brastianos P, Sabah D (2003) Surgical treatment of primary sacral tumors: complications associated with sacrectomy. Neurosurg Focus 15:E9PubMedGoogle Scholar
  3. 3.
    Kayani B, Hanna SA, Sewell MD, Saifuddin A, Molloy S, Briggs TW (2014) A review of the surgical management of sacral chordoma. Eur J Surg Oncol. doi: 10.1016/j.ejso.2014.04.008 PubMedGoogle Scholar
  4. 4.
    Varga PP, Szövérfi Z, Lazary A (2014) Surgical treatment of primary malignant tumors of the sacrum. Neurol Res 36:577–587PubMedCrossRefGoogle Scholar
  5. 5.
    Fourney DR, Rhines LD, Hentschel SJ, Skibber JM, Wolinsky JP, Weber KL, Suki D, Gallia GL, Garonzik I, Gokaslan ZL (2005) En bloc resection of primary sacral tumors: classification of surgical approaches and outcome. J Neurosurg Spine 3:111–122PubMedCrossRefGoogle Scholar
  6. 6.
    Asavamongkolkul A, Waikakul S (2012) Wide resection of sacral chordoma via a posterior approach. Int Orthop 36:607–612PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Guo W, Tang X, Zang J, Ji T (2013) One-stage total en bloc sacrectomy: a novel technique and report of 9 cases. Spine (Phila Pa 1976) 38:E626–E631CrossRefGoogle Scholar
  8. 8.
    Clarke MJ, Dasenbrock H, Bydon A, Sciubba DM, McGirt MJ, Hsieh PC, Yassari R, Gokaslan ZL, Wolinsky JP (2012) Posterior-only approach for en bloc sacrectomy: clinical outcomes in 36 consecutive patients. Neurosurgery 71:357–364PubMedCrossRefGoogle Scholar
  9. 9.
    Angelini A, Ruggieri P (2013) A new surgical technique (modified Osaka technique) of sacral resection by posterior-only approach: description and preliminary results. Spine (Phila Pa 1976) 38:E185–E192CrossRefGoogle Scholar
  10. 10.
    Solomon MJ, Tan KK, Bromilow RG, Al-mozany N, Lee PJ (2014) Sacrectomy via the abdominal approach during pelvic exenteration. Dis Colon Rectum 57:272–277PubMedCrossRefGoogle Scholar
  11. 11.
    Saigal R, Lu DC, Deng DY, Chou D (2014) Conversion of high sacral to midsacral amputation via S-2 nerve preservation during partial S-2 sacrectomy for chordoma. J Neurosurg Spine 20:421–429PubMedCrossRefGoogle Scholar
  12. 12.
    Li D, Guo W, Tang X, Yang R, Tang S, Qu H, Yang Y, Sun X, Du Z (2013) Preservation of the contralateral sacral nerves during hemisacrectomy for sacral malignancies. Eur Spine J (Epub ahead of print)Google Scholar
  13. 13.
    Jahangiri FR, Al Eissa S, Jahangiri AF, Al-Habib A (2013) Intraoperative neurophysiological monitoring during sacrectomy procedures. Neurodiagn J 53:312–322PubMedGoogle Scholar
  14. 14.
    Devor M (2013) Neuropathic pain: pathophysiologic response of nerves to injury. In: McMahon SB, Koltzenburg M, Tracey I, Turk D (eds) Wall and Melzack textbook of pain, 6th edn. Elsevier, Philadelphia, pp 861–888Google Scholar
  15. 15.
    Jensen MP, Chodroff MJ, Dworkin RH (2007) The impact of neuropathic pain on health-related quality of life: review and implications. Neurology 68:1178–1182PubMedCrossRefGoogle Scholar
  16. 16.
    O’Connor AB (2009) Neuropathic pain: a review of the quality of life impact, costs, and cost-effectiveness of therapy. Pharmacoeconomics 27:95–112PubMedCrossRefGoogle Scholar
  17. 17.
    Hansson PT (2008) Neuropathic pain: definition, diagnosis criteria, clinical phenomenology, and differential diagnosis issues. In: Castro-Lopes J, Raja S, Schmelz M (eds) Pain 2008: an updated review, refresher course syllabus. IASP Press, Seattle, pp 271–276Google Scholar
  18. 18.
    Sherman RA (2003) Postamputation pain. In: Jensen TS, Wilson PR, Rice ASC (eds) Clinical pain management: chronic pain, 1st edn. Arnold, London, pp 427–436Google Scholar
  19. 19.
    Chavez NF, Zweizig SL, Stewart EA (2003) Neuropathic uterine pain after hysterectomy. A case report. J Reprod Med 48:466–468PubMedGoogle Scholar
  20. 20.
    Rothemund Y, Grosser SM, Liebeskind U, Schlag PM, Flor H (2004) Phantom phenomena in mastectomized patients and their relation to chronic and acute pre-mastectomy pain. Pain 107:140–146PubMedCrossRefGoogle Scholar
  21. 21.
    Nikolajsen L, Jensen TS (2006) Phantom pain. In: McMahon SB, Koltzenburg M (eds) Wall and Melzack’s textbook of pain, 5th edn. Elsevier, Churchill Livingstone, China, pp 961–972CrossRefGoogle Scholar
  22. 22.
    Marbach JJ, Raphael KG (2000) Phantom tooth pain: a new look at an old dilemma. Pain Med 1:68–77PubMedCrossRefGoogle Scholar
  23. 23.
    Hsu C, Sliwa JA (2004) Phantom breast pain as a source of functional loss. Am J Phys Med Rehabil 83(8):659–662PubMedCrossRefGoogle Scholar
  24. 24.
    Guo Y, Yadav R (2002) Improving function after total sacrectomy by using a lumbar-sacral corset. Am J Phys Med Rehabil 81:72–76PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
  2. 2.BangkokThailand

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