Disclosures: Annette Lukose, MD: Nothing to disclose

Case Description: Sacral chordoma in a 73-year-old male with bowel and bladder dysfunction.

Setting: Inpatient

Patient: Patient is a 73-year-old male who presented to the emergency department with complaints of constipation and gluteal pain exacerbated by sitting. Of note, the patient was seen 1 month prior with similar complaints, but x-rays were negative, and the patient was discharged home after fleet enema. The patient also had recent appointment with outpatient urology to have an indwelling Foley catheter placed for urinary retention.

Assessment/Results: Physical exam showed decreased strength in lower extremities, coccygeal tenderness, decreased rectal tone, and no sensory deficits. CT abdomen/pelvis revealed a 10 cm pelvic mass arising posterior to the rectum, invading the left gluteus maximus, and destroying the distal sacrum and coccyx. Biopsy showed sacral chordoma. After discussion of treatment options, patient consented to en bloc tumor resection and PM&R was consulted for pre-operative functional evaluation. Prior to surgery, he was transferred to a different tertiary hospital per request.

Discussion: Chordomas are rare bone tumors (1:1,000,000 incidence) that arise from remnants of the notochord, with 50% involving the sacrum. Sacrectomy is the mainstay treatment. Due to delayed presentation of symptoms, they are typically large at the time of diagnosis and locally invasive, which often compromises sacral nerve roots during tumor resection. Early diagnosis is important as pre-operative bladder, bowel, motor function, and level of sacral tumor involvement are the greatest predictors of long-term functional outcomes post-sacrectomy. Literature suggests that post-sacrectomy patients generally do not receive acute inpatient rehabilitation; however, retrospective studies point to improvement in functional independence measure scores for patients who do.

Conclusion: A high index of suspicion is required to diagnose this rare disease, especially when chronic gluteal pain is associated with neurological symptoms. Additionally, physiatrists should be aware that post-sacrectomy patients may benefit from acute inpatient rehabilitation following surgery.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/sacral-chordoma-causing-bladder-and-bowel-dysfunction/