Prevalence of neuropathic pain after radical sacral chordoma resection: an observational cohort study with 10-year follow-up

Abstract

This study was carried out to discover the prevalence, characteristics and severity of neuropathic pain after wide resection of chordoma of the sacrum by the use of posterior approach. Patients who had chordoma of their sacrums and underwent wide resection via posterior approach, during 1990-2002, were followed up as a prospective cohort. Pain assessment was carried out in terms of onset, characteristics, intensity (numerical rating scale), response to pain medication and associated symptoms. The correlation between patients' biographic data, preoperative neuropathic pain, type and levels of surgery and pain were analyzed. There were 21 patients; 14 male and 7 female patients. Their ages ranged between 29 and 75 years. Subtotal sacrectomy was carried out in 9 patients and total sacrectomy was carried out in 12 patients. All patients survived the operation. Neuropathic pain was found in 11 patients (52.4%). Male patients and presentation of preoperative neuropathic pain were significantly related to postoperative neuropathic pain. The other factors were not related to the postoperative pain. Recurrent of severe pain with different characteristics after the operation might indicate tumor recurrent. Early detection of the pain and proper treatment could minimize pain intensity and improved pain management satisfaction.

Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group

“…Worsening of pain and/or of neurologic symptoms can be the first sign of disease relapse/progression even when this cannot be yet detected radiologically [42]. …”

Image‐guided percutaneous cryoablation of unresectable sacrococcygeal chordoma: Feasibility and outcome in a selected group of patients with long term follow‐up

“…Lower extremity motor or sensitive deficits are expected with higher sacral levels 7 . Finally, chronic pain often develops, causing anxiety, and depression 8‐10 …”

“…7 Finally, chronic pain often develops, causing anxiety, and depression. [8][9][10] Recently introduced therapies, especially proton-and carbon-ion beam radiation therapy, have increased the rate of conservative treatment. 11,12 Medical treatments, including targeted therapies and immunotherapy, are still under evaluation and the Chordoma Global Consensus Group stressed in 2017 the urgent need for efficient medical therapies for unresectable chordomas.…”

“…All four patients developed local recurrence (recurrence rate 100%) after a mean of 10.5 months (range[7][8][9][10][11][12][13][14][15][16]. Altogether, 9 of the 10 lesions recurred (six lesions in four patients, some treated several times [see above]), yielding a progression rate of 90%.…”

“…Altogether, 9 of the 10 lesions recurred (six lesions in four patients, some treated several times [see above]), yielding a progression rate of 90%. The mean time to progression after PCA for the 10 procedures was 8.1 months (range 1 [5][6][7][8][9][10][11][12][13][14][15][16]…”