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

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/complex-rehabilitation-needs-of-an-adult-with-a-sacral-chordoma-status-post-sacrectomy-a-case-report/