Session Information
Session Title: AA 2022 Posters - General Rehabilitation
Session Time: None. Available on demand.
Disclosures: Rahul H. Koya, DO: No financial relationships or conflicts of interest
Case Diagnosis: A 61-year-old female with a sacral chordoma
Case Description or Program Description: A 61-year-old female reported one-month history of worsening low back pain and associated difficulty ambulating. Magnetic resonance imaging of the lumbar spine revealed a well-defined enhancing expansile lytic sacral mass at the S2-S3 level, likely representative of a plasmacytoma or chordoma. The patient underwent a midline laparotomy, L5-S1 anterior lumbar interbody fusion with femoral head allograft, ostomy creation, L4-pelvis fusion, and high-level sacrectomy with flap closure using rectus abdominis muscle. The patient subsequently had residual paraparesis and neurogenic bladder.
Setting: Inpatient Acute Rehabilitation Floor
Assessment/Results: During her acute rehab stay, the patient required: multimodal pain control with lidocaine cream, hydromorphone, gabapentin, and methocarbamol; neurogenic bladder management with clean intermittent catheterization; and bowel maintenance with routine colostomy care along with senna, bisacodyl, and polyethylene glycol. Her rehab course was complicated by the development of post-operative cystitis requiring antibiotics. The patient was also referred to radiation oncology with plan to start post-operative radiation therapy. With consistent physical and occupational therapy, the patient was able to ambulate independently with a rolling walker and was discharged home.
Discussion (relevance): Sacral chordomas are rare malignant tumors typically managed surgically that can cause neurogenic bladder and paraparesis. We describe a patient with complex rehab needs who was ultimately able to return home due to evaluation and treatment of pain and bowel/bladder dysfunction.
Conclusions: In sacral chordoma patients status-post sacrectomy, a strong multidisciplinary rehab approach is paramount in achieving adequate functional improvement with independent ambulation and bladder management.
Level of Evidence: Level V
To cite this abstract in AMA style:
Koya RH, Ferguson R, Mensch J. Complex Rehabilitation Needs of an Adult with a Sacral Chordoma Status Post Sacrectomy: A Case Report [abstract]. PM R. 2022; 14(S1)(suppl 1). https://pmrjabstracts.org/abstract/complex-rehabilitation-needs-of-an-adult-with-a-sacral-chordoma-status-post-sacrectomy-a-case-report/. Accessed September 7, 2024.« Back to AAPM&R Annual Assembly 2022
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/complex-rehabilitation-needs-of-an-adult-with-a-sacral-chordoma-status-post-sacrectomy-a-case-report/