Case study: Successful sacrectomy in elderly Tri-County patient
An 80-year-old male in good health presented with urinary incontinence. Preliminary imaging revealed a cantaloupe-sized mass in his pelvis pressing against his bladder and sacrum.
When a biopsy revealed the mass to be a rare type of bone cancer called chordoma, the case was referred to Matthew Neal, MD, one of our board-certified neurological surgeons.
Treatment of sacral chordomas typically includes sacrectomy, a complex procedure that requires navigating critical blood vessels and collaborating with other specialists. Experience with this procedure is rare outside of academic medical centers, but Dr. Neal treated multiple chordomas during his fellowship and early career and has resected similar masses at Roper St. Francis Healthcare.
Dr. Neal received the referral on a Friday and met with the patient the following Tuesday. He consulted with Roper St. Francis colleagues in colorectal surgery, urology and plastic surgery, who played critical roles in planning the surgery and preparing the patient.
“This was a team effort. I’m proud that our system has the resources and experience this patient needed for successful treatment — without having to wait or travel,” Dr. Neal says.
Two-stage surgery and a full recovery
The coordinated care plan began right away with urodynamic studies, abdominal imaging, lumbar scans and other tests.
“The imaging located all the structures I needed to protect, especially the adjacent blood vessels. You can lose a significant amount of blood very quickly if you inadvertently damage those on your approach,” Dr. Neal explains.
Preoperative testing also revealed the tumor had damaged nerves controlling the patient’s bladder sphincter. Unfortunately, the patient’s urinary incontinence would continue after surgery.
Surgery took place 14 days after referral. The 10-hour surgery proceeded in two stages:
- Stage one (anterior): The urologist placed stents in the ureters to ensure they and the kidneys weren’t damaged. The colorectal surgeon resected the bulk of the tumor, and Dr. Neal released a portion of the sacrum.
- Stage two (posterior): Dr. Neal completed the sacrectomy using intraoperative CT and guided instruments. The plastic surgeon then stepped in to reconstruct the patient’s tissue and close the case.
Chordomas are resistant to conventional radiation, so the patient received proton-beam radiation at another center after his surgery.
The patient has since returned to all his favorite activities, including regular exercise at the gym. He has full motor function in his legs and no lingering pain issues, and uses an intermittent catheter to manage his bladder incontinence.
“He just sent us a note to say how appreciative he was. He’s a wonderful patient. Knowing he’s out there, hitting the gym at 80, is hugely satisfying for our whole team,” Dr. Neal says.
Why Roper St. Francis Neurosurgery?
Patients at Roper St. Francis Neurosurgery receive a unique blend of world-class expertise and personalized, multidisciplinary care. We have four convenient locations across the Tri-County area and started offering inpatient neurosurgery procedures at Berkeley Hospital in November.
We recently overhauled our referral process to enable fast, convenient access. We review urgent referrals the same day we receive them and all other referrals within 48 hours. We can typically see non-urgent patients within 48 hours if they are flexible on provider and location. Intake teams ensure every patient receives appropriate imaging and is routed to the appropriate next step, from surgical evaluation to rehab.
Ways to refer
Epic: Use referral code Roper St. Francis Physician Partners-Roper St. Francis Spine Intake Clinic or select the specific provider you’d like your patient to see.
Fax referrals to (843) 606-8059
Call (843) 723-8823 to make a referral.
Please indicate the following:
- Urgent or non-urgent
- Specify whether you want a specific provider or the next available appointment with any provider.