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Case report

bulletA young 45 years age, underwent several operations for sacrococcygeal chordoma , followed by radiation  6000 Rad 1998. He came to the clinic with a huge mass. He had bilateral drop feet with inability to walk, with micturition problems, for what he was operated  1998: Removal of the tumor was undertaken with preservation of the L5 down to the coccygeal nerves. It was impossible to remove the tumor dirt invading the neural structures. The pelvic cavity was not violated. Using modified bended Luque, fixation of L3-4-5 was achieved with the iliac bones with wires. The operation was bloody and the patient required 26 units of blood with 12 units of FFP. Despite that the wound was complicated by infection, the neurological state of the patient improved and he could walk without aid and the micturition  improved.

The patient then came another time with recurrence and was operated 6-11-2000. The pathologic bone structures and about 3 cm of the surrounding healthy bone was removed and the pelvic cavity was violated , with dissection of the tumor from the ano-rectal structures and dissection of the tumor off the aorto-iliac arteries and veins. The Luque construct was aided with another metallic devices , so as to regain more fixation, down to the acetabular surfaces above the hip joints. 
 
The patient then came 10-4-2004 with complains of left leg pain with inability to stand  for 9 months  with prominent scoliotic deformity of the pelvis.  On examination, the patient had hypalgesia  left L5 and S1 territories with drop left foot  with weak planterflexion both feet. It was evident that the device was loose in in the right side. The patient was admitted and operated through the right iliac region to booster the fixation. During that, it was noticed that recurrence of the tumor had place, and it was the reason for bone loosening.

 

Postoperative CT-scan.

Postoperative studies:

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Postoperative MRI frontal views

Postoperative MRI sagital views.


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[2005] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved