Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive sacral pain, localized to the midline/gluteal region, exacerbated by sitting and weight-bearing. Associated symptoms include radicular pain in the S1-S3 distribution, saddle anesthesia, and recent onset of bowel/bladder dysfunction. No constitutional symptoms of fever or weight loss.
Clinical Examination Findings
Physical exam reveals localized tenderness over the sacrum. Neurological assessment shows diminished sensation in the perianal region (saddle distribution), decreased strength in plantar flexion (S1) and toe extension (L5), and diminished or absent Achilles reflexes. Gait is antalgic. Rectal exam confirms mass effect or tenderness consistent with sacral involvement.
Treatment Protocol
Recommended management includes surgical resection (curettage or en-bloc sacrectomy) depending on tumor extent and stability. Adjuvant therapy with denosumab may be considered for unresectable or recurrent cases. Post-operative stabilization with sacral instrumentation and fusion may be required. Multidisciplinary approach involving neurosurgery, orthopedic oncology, and radiation oncology.