Sacral Spinal Tumors



Tumors of the sacral spine are rare, comprising up to only 7% of all spinal tumors. They can be broadly categorized into two groups: primary or metastatic. Primary sacral tumors can be further divided into three groups based on origin: congenital, neurogenic, or osseous. The most common primary sacral tumor is the chordoma. The most common sacral tumor is from metastasis.


Sacral tumor Chordoma Metastases Primary spine tumor 


  1. 1.
    Feldenzer JA, McGauley JL, McGillicuddy JE. Sacral and presacral tumors: problems in diagnosis and management. Neurosurgery. 1989;25(6):884–91.CrossRefGoogle Scholar
  2. 2.
    Hambraeus M, Arnbjornsson E, Borjesson A, Salvesen K, Hagander L. Sacrococcygeal teratoma: a population-based study of incidence and prenatal prognostic factors. J Pediatr Surg. 2016;51(3):481–5. Scholar
  3. 3.
    Gokaslan Z, Hsu W. Surgical resection of sacral tumors. In: Quinones-Hinojosa A, editor. Schmidek and sweet operative neurosurgical techniques. Philadelphia: Elsevier; 2012.Google Scholar
  4. 4.
    Altman RP, Randolph JG, Lilly JR. Sacrococcygeal teratoma: American Academy of Pediatrics surgical section Survey-1973. J Pediatr Surg. 1974;9(3):389–98.CrossRefGoogle Scholar
  5. 5.
    Kremer ME, Wellens LM, Derikx JP, van Baren R, Heij HA, Wijnen MH, Wijnen RM, van der Zee DC, van Heurn LW. Hemorrhage is the most common cause of neonatal mortality in patients with sacrococcygeal teratoma. J Pediatr Surg. 2016;51(11):1826–9. Scholar
  6. 6.
    Rescorla FJ, Sawin RS, Coran AG, Dillon PW, Azizkhan RG. Long-term outcome for infants and children with sacrococcygeal teratoma: a report from the Childrens Cancer group. J Pediatr Surg. 1998;33(2):171–6.CrossRefGoogle Scholar
  7. 7.
    Hambraeus M, Hagander L, Stenstrom P, Arnbjornsson E, Borjesson A. Long-term outcome of Sacrococcygeal Teratoma: a controlled cohort study of urinary tract and bowel dysfunction and predictors of poor outcome. J Pediatr. 2018;198:131–136.e2. Scholar
  8. 8.
    Fourney DR, Gokaslan ZL. Current management of sacral chordoma. Neurosurg Focus. 2003;15(2):E9.CrossRefGoogle Scholar
  9. 9.
    Sui J, Zadnik PL, Groves ML, Gokaslan ZL. Chordoma. In: Vialle LR, editor. AO spine masters series volume 2: primary spinal tumors. New York: Thieme; 2015.Google Scholar
  10. 10.
    Helbig D. Subcutaneous sacral ependymoma--a histopathological challenge. J Cutan Pathol. 2016;43(1):71–4. Scholar
  11. 11.
    Shaw EG, Evans RG, Scheithauer BW, Ilstrup DM, Earle JD. Postoperative radiotherapy of intracranial ependymoma in pediatric and adult patients. Int J Radiat Oncol Biol Phys. 1987;13(10):1457–62.CrossRefGoogle Scholar
  12. 12.
    Sonneland PR, Scheithauer BW, Onofrio BM. Myxopapillary ependymoma. A clinicopathologic and immunocytochemical study of 77 cases. Cancer. 1985;56(4):883–93.CrossRefGoogle Scholar
  13. 13.
    Quraishi NA, Wolinsky JP, Bydon A, Witham T, Gokaslan ZL. Giant destructive myxopapillary ependymomas of the sacrum. J Neurosurg Spine. 2010;12(2):154–9. Scholar
  14. 14.
    Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114(2):97–109. Scholar
  15. 15.
    Sobowale O, Ibrahim I, du Plessis D, Herwadkar A, Tzerakis N. Dumbbell ganglioneuroma mimicking lumbar neurofibroma: a case report and review of the literature. Br J Neurosurg. 2013;27(4):521–3. Scholar
  16. 16.
    Levy DI, Bucci MN, Weatherbee L, Chandler WF. Intradural extramedullary ganglioneuroma: case report and review of the literature. Surg Neurol. 1992;37(3):216–8.CrossRefGoogle Scholar
  17. 17.
    Miyakoshi N, Hongo M, Kasukawa Y, Misawa A, Shimada Y. Bilateral and symmetric C1-C2 dumbbell ganglioneuromas associated with neurofibromatosis type 1 causing severe spinal cord compression. Spine J. 2010;10(4):e11–5. Scholar
  18. 18.
    Bacci C, Sestini R, Ammannati F, Bianchini E, Palladino T, Carella M, Melchionda S, Zelante L, Papi L. Multiple spinal ganglioneuromas in a patient harboring a pathogenic NF1 mutation. Clin Genet. 2010;77(3):293–7. Scholar
  19. 19.
    Ogden AT, Schwartz TH, McCormick PC. Spinal cord tumors in adults. In: Winn HR, editor. Youmans neurological surgery. Philadelphia: Elsevier; 2011.Google Scholar
  20. 20.
    Alfieri A, Campello M, Broger M, Vitale M, Schwarz A. Low-back pain as the presenting sign in a patient with a giant, sacral cellular schwannoma: 10-year follow-up. J Neurosurg Spine. 2011;14(2):167–71. Scholar
  21. 21.
    Turk PS, Peters N, Libbey NP, Wanebo HJ. Diagnosis and management of giant intrasacral schwannoma. Cancer. 1992;70(11):2650–7.CrossRefGoogle Scholar
  22. 22.
    Muramatsu K, Ihara K, Kato Y, Yoshida Y, Taguchi T. Intrasacral schwannoma: clinical presentation, diagnosis and management. Br J Neurosurg. 2008;22(6):790–2. Scholar
  23. 23.
    Abernathey CD, Onofrio BM, Scheithauer B, Pairolero PC, Shives TC. Surgical management of giant sacral schwannomas. J Neurosurg. 1986;65(3):286–95. Scholar
  24. 24.
    Seppala MT, Haltia MJ, Sankila RJ, Jaaskelainen JE, Heiskanen O. Long-term outcome after removal of spinal neurofibroma. J Neurosurg. 1995;82(4):572–7. Scholar
  25. 25.
    Llauger J, Palmer J, Amores S, Bague S, Camins A. Primary tumors of the sacrum: diagnostic imaging. AJR Am J Roentgenol. 2000;174(2):417–24. Scholar
  26. 26.
    Atesok KI, Alman BA, Schemitsch EH, Peyser A, Mankin H. Osteoid osteoma and osteoblastoma. J Am Acad Orthop Surg. 2011;19(11):678–89.CrossRefGoogle Scholar
  27. 27.
    Nadeau M, Dipaola C. Spinal osteoid osteoma and osteoblastoma. In: Vialle LR, editor. AO spine masters series volume 2: primary spinal tumors. New York: Thieme; 2015.Google Scholar
  28. 28.
    Lee EH, Shafi M, Hui JH. Osteoid osteoma: a current review. J Pediatr Orthop. 2006;26(5):695–700. Scholar
  29. 29.
    Lundeen MA, Herring JA. Osteoid-osteoma of the spine: sclerosis in two levels. A case report. J Bone Joint Surg Am. 1980;62(3):476–8.CrossRefGoogle Scholar
  30. 30.
    Lucas DR, Unni KK, McLeod RA, O'Connor MI, Sim FH. Osteoblastoma: clinicopathologic study of 306 cases. Hum Pathol. 1994;25(2):117–34.CrossRefGoogle Scholar
  31. 31.
    Manaster BJ, Graham T. Imaging of sacral tumors. Neurosurg Focus. 2003;15(2):E2.CrossRefGoogle Scholar
  32. 32.
    Brastianos P, Gokaslan Z, McCarthy EF. Aneurysmal bone cysts of the sacrum: a report of ten cases and review of the literature. Iowa Orthop J. 2009;29:74–8.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Boriani S, Bandiera S, Ghermandi R. Aneurysmal bone cyst and giant cell tumor. In: Vialle LR, editor. AO spine masters series volume 2: primary spinal tumors. New York: Thieme; 2015.Google Scholar
  34. 34.
    Luther N, Bilsky MH, Hartl R. Giant cell tumor of the spine. Neurosurg Clin N Am. 2008;19(1):49–55. Scholar
  35. 35.
    Domovitov SV, Chandhanayingyong C, Boland PJ, McKeown DG, Healey JH. Conservative surgery in the treatment of giant cell tumor of the sacrum: 35 years' experience. J Neurosurg Spine. 2015;24:1–13. Scholar
  36. 36.
    McLoughlin GS, Sciubba DM, Wolinsky JP. Chondroma/chondrosarcoma of the spine. Neurosurg Clin N Am. 2008;19(1):57–63. Scholar
  37. 37.
    York JE, Berk RH, Fuller GN, Rao JS, Abi-Said D, Wildrick DM, Gokaslan ZL. Chondrosarcoma of the spine: 1954 to 1997. J Neurosurg. 1999;90(1 Suppl):73–8.PubMedGoogle Scholar
  38. 38.
    Normand AN, Ballo MT, Yasko AW. Palliative radiation therapy for advanced chondrosarcoma. Proc Conn Tiss Oncol Soc. 2006;12:745.Google Scholar
  39. 39.
    Schoenfeld AJ, Hornicek FJ, Pedlow FX, Kobayashi W, Raskin KA, Springfield D, Delaney TF, Nielsen GP, Mankin HJ, Schwab JH. Chondrosarcoma of the mobile spine: a review of 21 cases treated at a single center. Spine (Phila Pa 1976). 2012;37(2):119–26. Scholar
  40. 40.
    Nishizawa K, Mori K, Saruhashi Y, Takahashi S, Matsusue Y. Long-term clinical outcome of sacral chondrosarcoma treated by total en bloc sacrectomy and reconstruction of lumbosacral and pelvic ring using intraoperative extracorporeal irradiated autologous tumor-bearing sacrum: a case report with 10 years follow-up. Spine J. 2014;14(5):e1–8. Scholar
  41. 41.
    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(3):244–56. Scholar
  42. 42.
    Sciubba DM, Okuno SH, Dekutoski MB, Gokaslan ZL. Ewing and osteogenic sarcoma: evidence for multidisciplinary management. Spine (Phila Pa 1976). 2009;34(22 Suppl):S58–68. Scholar
  43. 43.
    Ozaki T, Flege S, Liljenqvist U, Hillmann A, Delling G, Salzer-Kuntschik M, Jurgens H, Kotz R, Winkelmann W, Bielack SS. Osteosarcoma of the spine: experience of the cooperative osteosarcoma study group. Cancer. 2002;94(4):1069–77.CrossRefGoogle Scholar
  44. 44.
    Kelley SP, Ashford RU, Rao AS, Dickson RA. Primary bone tumours of the spine: a 42-year survey from the Leeds regional bone tumour registry. Eur Spine J. 2007;16(3):405–9. Scholar
  45. 45.
    Schoenfeld AJ, Hornicek FJ, Pedlow FX, Kobayashi W, Garcia RT, Delaney TF, Springfield D, Mankin HJ, Schwab JH. Osteosarcoma of the spine: experience in 26 patients treated at the Massachusetts General Hospital. Spine J. 2010;10(8):708–14. Scholar
  46. 46.
    Ju DG, Zadnik PL, Sciubba DM. Osteogenic sarcoma and Ewing’s sarcoma of the spine. In: Vialle LR, editor. AO spine masters series volume 2: primary spinal tumors. New York: Thieme; 2015.Google Scholar
  47. 47.
    Link MP, Goorin AM, Miser AW, Green AA, Pratt CB, Belasco JB, Pritchard J, Malpas JS, Baker AR, Kirkpatrick JA, et al. The effect of adjuvant chemotherapy on relapse-free survival in patients with osteosarcoma of the extremity. N Engl J Med. 1986;314(25):1600–6. Scholar
  48. 48.
    Shives TC, Dahlin DC, Sim FH, Pritchard DJ, Earle JD. Osteosarcoma of the spine. J Bone Joint Surg Am. 1986;68(5):660–8.CrossRefGoogle Scholar
  49. 49.
    Evans RG, Nesbit ME, Gehan EA, Garnsey LA, Burgert O Jr, Vietti TJ, Cangir A, Tefft M, Thomas P, Askin FB, et al. Multimodal therapy for the management of localized Ewing's sarcoma of pelvic and sacral bones: a report from the second intergroup study. J Clin Oncol. 1991;9(7):1173–80. Scholar
  50. 50.
    Grier HE, Krailo MD, Tarbell NJ, Link MP, Fryer CJ, Pritchard DJ, Gebhardt MC, Dickman PS, Perlman EJ, Meyers PA, Donaldson SS, Moore S, Rausen AR, Vietti TJ, Miser JS. Addition of ifosfamide and etoposide to standard chemotherapy for Ewing's sarcoma and primitive neuroectodermal tumor of bone. N Engl J Med. 2003;348(8):694–701. Scholar
  51. 51.
    Ozdemir MH, Gurkan I, Yildiz Y, Yilmaz C, Saglik Y. Surgical treatment of malignant tumours of the sacrum. Eur J Surg Oncol. 1999;25(1):44–9. Scholar
  52. 52.
    Payer M. Neurological manifestation of sacral tumors. Neurosurg Focus. 2003;15(2):1–6. Scholar
  53. 53.
    Zhang HY, Thongtrangan I, Balabhadra RS, Murovic JA, Kim DH. Surgical techniques for total sacrectomy and spinopelvic reconstruction. Neurosurg Focus. 2003;15(2):E5.CrossRefGoogle Scholar
  54. 54.
    Du Z, Guo W, Yang R, Tang X, Ji T, Li D. What is the value of surgical intervention for sacral metastases? PLoS One. 2016;11(12):e0168313. Scholar
  55. 55.
    Gilinsky NH, Burns DG, Barbezat GO, Levin W, Myers HS, Marks IN. The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients. Q J Med. 1983;52(205):40–53.PubMedGoogle Scholar
  56. 56.
    Maas JM. Intestinal changes secondary to irradiation of pelvic malignancies. Am J Obstet Gynecol. 1948;56(2):249–59.CrossRefGoogle Scholar
  57. 57.
    O'Brien PC, Franklin CI, Dear KB, Hamilton CC, Poulsen M, Joseph DJ, Spry N, Denham JW. A phase III double-blind randomised study of rectal sucralfate suspension in the prevention of acute radiation proctitis. Radiother Oncol. 1997;45(2):117–23.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryWarren Alpert School of Medicine at Brown University, Rhode Island HospitalProvidenceUSA

Personalised recommendations