CASE REPORT   Free access

European Journal of Physical and Rehabilitation Medicine 2019 August;55(4):526-9

DOI: 10.23736/S1973-9087.18.05112-2

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

The challenges of providing rehabilitation for patients undergoing sacrectomy: two case reports

George J. FRANCIS ¹, An NGO-HUANG ² ✉, Laurence D. RHINES ³, Eduardo BRUERA ²

¹ Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; ² Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; ³ Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA

BACKGROUND: Sacral neoplasms often present as large masses that often require sacrectomy. Multiple sacral nerve roots may be compromised post-sacrectomy and postoperative complications may result in impaired mobility, pain, orthostasis, and neurogenic bowel and bladder.
CASE SERIES: Case 1, 58 year-old female with a sacral solitary fibrous tumor underwent a high-level sacrectomy and bilateral gluteal muscle flaps. Her rehabilitation course included management of pain, orthostasis, and neurogenic bowel and bladder. Case 2, 67 year-old male with sacral chordoma underwent high-level sacrectomy and bilateral gluteal muscle flaps. His rehabilitation course was complicated by refractory orthostatic hypotension, pain, and wound impairment, which resulted in slow rehabilitation progression and bowel and bladder training. Progression of activity in both cases was limited by surgical restrictions to support wound healing.
CLINICAL REHABILITATION IMPACT: Multidisciplinary efforts after a sacrectomy are vital to successful rehabilitation. Highly functional outcomes are seen, including independent bowel and bladder management and return to preoperative ambulatory status.

KEY WORDS: Sacrum; Chordoma; Neurological rehabilitation