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Sacral Metastases

  • A. Karim Ahmed
  • C. Rory Goodwin
  • Daniel M. Sciubba
Chapter

Abstract

The sacrum plays a dynamic role in protecting the pelvic viscera, distributing load, and adjoining the spinal column to the pelvis and encompasses nerves with motor, sensory, and autonomic functions. Metastatic spine disease of the sacrum is more common than primary tumors. Although there is no unifying clinical presentation for sacral metastases, pain is most common initial symptom due largely to mass effect. Diagnosis of tumor etiology, dependent on imaging and biopsy, is imperative because it can significantly alter management. The treatment options for metastatic spine disease of the sacrum may include adjuvant therapy, radiation, surgery, and cement augmentation. Clinical presentation, primary tumor etiology, and prognosis are essential factors in determining the most appropriate treatment for these patients.

Keywords

Spine Sacrum Metastases Sacral tumor Spinal oncology 

References

  1. 1.
    Feldenzer JA, McGauley JL, McGillicuddy JE. Sacral and presacral tumors: problems in diagnosis and management. Neurosurgery. 1989;25:884–91.CrossRefPubMedGoogle Scholar
  2. 2.
    Bogduk N. Clinical anatomy of the lumbar spine and sacrum. 4th ed. Philadephia, PA: Elsevier; 2005. p. 59–76.Google Scholar
  3. 3.
    Wang T, Fielding LC, Parikh A, Kothari M, Alamin T. Sacral spinous processes; a morphologic classification and biomechanical characterization of strength. Spine J. 2015;15(12):2544–51.CrossRefPubMedGoogle Scholar
  4. 4.
    Sae-Jung S, Khamanarong K, Woraputtaporn W, Amarttayakong P. Awareness of the median sacral artery during lumbosacral spinal surgery: an anatomic cadaveric study of its relationship to the lumbosacral spine. Eur Spine J. 2015;24(11):2520–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Zoccali C, Skoch J, Patel A, Walter CM, Maykowski P, Baaj AA. The surgical neurovascular anatomy relating to partial and complete sacral and sacroiliac resections: a cadaveric, anatomic study. Eur Spine J. 2015;24(5):1109–13.CrossRefPubMedGoogle Scholar
  6. 6.
    Woon JT, Stringer MD. The anatomy of the sacrococcygeal corneal region and its clinical relevance. Anat Sci Int. 2014;89(4):207–14.CrossRefPubMedGoogle Scholar
  7. 7.
    Gray H. Gray’s anatomy: descriptive and applied. London, UK: Longmans; 1967. p. 286–547.Google Scholar
  8. 8.
    Rhee J, Kosztowski TA, Bydon M, Gokaslan ZL. Sacral tumors: regional challenges. In: Steinmets MP, Benzel EC, editors. Spine surgery: techniques, complications, avoidance, and management. 4th ed. Philadephia, PA: Elsevier; 2016. p. 1061–7.Google Scholar
  9. 9.
    Fourney DR, Gokaslan ZL. Surgical approaches for the resection of sacral tumors. In: Dickman CA, editor. Spinal cord and spinal column tumors: principles and practice. New York: Thieme; 2006. p. 632–6.Google Scholar
  10. 10.
    Payer M. Neurological manifestation of sacral tumors. Neurosurg Focus. 2003;1(2):1–6.CrossRefGoogle Scholar
  11. 11.
    Quraishi NA, Giannoulis KE, Edwards KL, Boszczyk BM. Management of metastatic sacral tumours. Eur Spine J. 2012;21(10):1984–93.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Feiz-Erfan I, Fox BD, Nader R, Suki D, Chakrabarti I, Mendel E, Gokaslan ZL, Rao G, Rhines LD. Surgical treatment of sacral metastases: indications and results. J Neurosurg Spine. 2012;17:285–91.CrossRefPubMedGoogle Scholar
  13. 13.
    Shah LM, Salsman KL. Imaging of spinal metastatic disease. Int J Surg Oncol. 2011;2011:1–12.CrossRefGoogle Scholar
  14. 14.
    Fukushima T, Kasai Y, Kato K, Fujisawa K, Uchida A. Intradural squamous cell carcinoma of the sacrum. World J Oncol. 2009;7:16.CrossRefGoogle Scholar
  15. 15.
    Pain GJ. Extremities and spine-evaluation and differential diagnosis. In: Omer G, Spinner M, Van Beek A, editors. Management of peripheral nerve problems. Philadelphia: WB Saunders; 1980. p. 169.Google Scholar
  16. 16.
    Sciubba DM, Petteys RJ, Garces-Ambrossi GL, Noggle JC, McGirt MJ, Wolinsky JP, Witham TF, Gokaslan ZL. Diagnosis and management of sacral tumors. J Neurosurg Spine. 2009;10:244–56.CrossRefPubMedGoogle Scholar
  17. 17.
    Norstrom CW, Kernohan JW, Love JG. One hundred primary caudad tumors. JAMA. 1961;178:1071–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Diel J, Ortiz O, Losada RA, Price DB, Hayt MW, Katz DS. The sacrum: pathologic spectrum, multimodality imaging, and subspecialty approach. Radiographics. 2001;21(1):83–104.CrossRefPubMedGoogle Scholar
  19. 19.
    Amorosa JK, Weintraub S, Amorosa LF, Safer JN, Rafii M. Sacral destruction: foraminal lines revisited. AJR. 1985;145(4):773–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Fourney DR, Gokaslan ZL. Sacral tumors: primary and metastatic. In: Dickman CA, Fehlings MG, Gokaslan ZL, editors. Spinal cord and spinal column tumors: principles and practice. New York: Thieme; 2006. p. 404–19.Google Scholar
  21. 21.
    Gerber S, Ollivier L, Leclere J, Vanel D, Missenard G, Brisse H, de Pinieux G, Neuenschwander S. Imaging of sacral tumours. Skelet Radiol. 2008;37(4):277–89.CrossRefGoogle Scholar
  22. 22.
    Algra PR, Bloem JL, Tissing H, FAlke TH, Arndt JW, Verteboom LJ. Detection of vertebral metastases: comparison between MR imaging and bone scintigraphy. Radiographics. 1991;11(2):219–32.CrossRefPubMedGoogle Scholar
  23. 23.
    Galasko CS. Mechanisms of lytic and blastic metastatic disease of bone. Clin Orthop Relat Res. 1982;(169):20–7.Google Scholar
  24. 24.
    Horger M, Bares R. The role of sing-photon emission computed tomography/computed tomography in benign and malignant bone disease. Semin Nucl Med. 2006;36(4):286–94.CrossRefPubMedGoogle Scholar
  25. 25.
    Savelli G, Chiti A, Grasselli G, Maccauro M, Rodai M, Bombardieri E. The role of bone SPECT study in diagnosis of single vertebral metastases. Anticancer Res. 2000;20:1115–20.PubMedGoogle Scholar
  26. 26.
    Bushnell DL, Kahn D, Huston B, Bevering CG. Utility of SPECT imaging for determination of vertebral metastases in patients with known primary tumors. Skelet Radiol. 1995;24:13–6.CrossRefGoogle Scholar
  27. 27.
    Laufer I, Sciubba DM, Madera M, Bydon A, Witham TJ, Gokaslan ZL, Wolinsky JP. Surgical management of metastatic spinal tumors. Cancer Control. 2012;19(2):122–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Babu NV, Titus VT, Chittaranjan S, Abraham G, Prem H, Korula RJ. Computed tomographically guided biopsy of the spine. Spine. 1994;19:439–44.CrossRefGoogle Scholar
  29. 29.
    Kattapuram SV, Khurana JS, Rosenthal DI. Percutaneous needle biopsy of the spine. Spine. 1992;17:561–4.CrossRefPubMedGoogle Scholar
  30. 30.
    Lis E, Bilsky MH, Pisinski L, Boland P, Healey JH, O’Malley B, et al. Percutaneous CT-guided biopsy of osseous lesion of the spine in patients with known or suspected malignancy. AJNR Am J Neuroradiol. 2004;25:1583–8.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Talamo G, Dimaio C, Abbi KKS, Pandey MK, Malysz J, Creer MH, Zhu J, Mir MA, Varlotto JM. Current role of radiation therapy for multiple myeloma. Front Oncol. 2015;5(40):1–6.Google Scholar
  32. 32.
    Gerszten PC, Mendel E, Yamada Y. Radiotherapy and radiosurgery for metastatic spine disease: what are the options, indications, and outcomes? Spine. 2009;34:S78–92.CrossRefPubMedGoogle Scholar
  33. 33.
    Laufer I, Rubin DG, Lis E, Cox BW, Stubblefield MD, Yamada Y, Bilsky MH. The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist. 2013;18(6):744–51.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Maranzano E, Bellavita R, Rossi R, et al. Short-course versus split-course radiotherapy in metastatic spinal cord compression: results of a phase III, randomized, multicenter trial. J Clin Oncol. 2005;23:3358–65.CrossRefPubMedGoogle Scholar
  35. 35.
    Fisher CG, DiPaola CP, Ryken TC, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spinal Oncology Study Group. Spine. 2010;35(2):E1221–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Bacci G, Savini R, Calderoni P, et al. Solitary plasmacytoma of the vertebral column: a report of 15 cases. Tumori. 1982;68(3):271–83.CrossRefPubMedGoogle Scholar
  37. 37.
    Patchell RA, Ribbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomized trial. Lancet. 2005;366(9486):643–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Bilsky MH, Laufer I, Burch S. Shifting paradigms in the treatment of metastatic spine disease. Spine. 2009;34(22):S101–7.CrossRefPubMedGoogle Scholar
  39. 39.
    Cybulski GR. Methods of surgical stabilization for metastatic disease of the spine. Neurosurgery. 1989;25:240–52.CrossRefPubMedGoogle Scholar
  40. 40.
    Founrey DR, Gokaslan ZL. Spinal instability and deformity due to neoplastic conditions. Neurosurg Focus. 2003;14(1):E8.Google Scholar
  41. 41.
    Fourney DR, Frangou EM, Ryken TC, et al. Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol. 2011;29(22):3072–7.CrossRefPubMedGoogle Scholar
  42. 42.
    Langdon J, Way A, Heaton S, Bernard J, Molloy S. The management of spinal metastases from renal cell carcinoma. Ann R Coll Surg Engl. 2009;91(8):649–52.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Stener B, Gunterberg B. High amputation of the sacrum for extirpation of tumors. Principles and technique. Spine (Phila Pa 1976). 1978;3(4):351–66.CrossRefGoogle Scholar
  44. 44.
    Althausen PL, Schneider PD, Bold RJ, Gupta MC, Goodnight JE, Khatri VP. Multimodality management of a giant cell tumor arising in the proximal sacrum: a case report. Spine. 2002;27(15):E361–5.CrossRefPubMedGoogle Scholar
  45. 45.
    Biagini R, Ruggieri P, Mercuri M, et al. Neurologic deficit after resection of the sacrum. Chir Organi Mov. 1997;82(4):357–72.PubMedGoogle Scholar
  46. 46.
    Ghogawala Z, Mansfield FL, Borges LF. Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine. 2001;26(7):818–24.CrossRefPubMedGoogle Scholar
  47. 47.
    Zhang J, Wu C, Gu Y, Li M. Percutaneous sacroplasty for sacral metastatic tumors under fluoroscopic guidance only. Korean J Radiol. 2008;9(6):572–6.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Whitlow CT, Mussat-Whitlow BJ, Mattern CWT, Baker MD, Morris PP. Sacroplasty versus vertebroplasty: comparable clinical outcomes for the treatment of fracture-related pain. AJNR Am J Neuroradiol. 2007;28:1266–70.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • A. Karim Ahmed
    • 1
  • C. Rory Goodwin
    • 2
  • Daniel M. Sciubba
    • 1
  1. 1.Department of NeurosurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of NeurosurgeryDuke University Medical CenterDurhamUSA

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