title: Maintenance of bowel, bladder, and motor functions after sacrectomy.
abstract: BACKGROUND
  Repeated cohort studies have consistently demonstrated a survival advantage after en bloc resection for locally aggressive primary tumors in the sacrum. A sacrectomy is often required to remove the tumor en bloc, which may necessitate the sacrifice of sacral nerves. This can potentially result in functional complications, including the impairment of gait, bowel function, or bladder function.
  
  
  OBJECTIVE
  To assess the bladder, bowel, and motor functions of patients after resection of a primary sacral tumor.
  
  
  METHODS
  This was a retrospective cohort study at a single academic institution.
  
  
  METHODS
  Consecutive patients who underwent an en bloc sacral tumor resection at a single institution between December 2002 and June 2012 were included. The study population comprised 73 patients.
  
  
  METHODS
  Patients were classified as having had a low, middle, high, or total sacrectomy based on the level of sacral nerves sacrificed, if applicable.
  
  
  METHODS
  Patient data were collected from clinic notes and hospital records that included operative notes, lab studies, and rehabilitation notes.
  
  
  RESULTS
  Across all patients, there was no change in bowel function after sacrectomy, whereas bladder and motor functions returned to preoperative (pre-op) levels at 3 and 6 months, respectively. Higher level sacrectomies were associated with worse bowel (p<.001), bladder (p<.001), and motor (p=.027) functions 12 months postoperatively (post-op). At 1 year, none of the six patients with a high or total sacrectomy had intact bladder function and 14.3% (N=7) had intact bowel function. Of patients with a middle sacrectomy, 62.5% (N=8) had intact bladder function and 71.4% (N=7) had intact bowel function at 1 year. Of patients with a low sacrectomy, 91.7% (N=12) had intact bladder function and 91.7% (N=12) had intact bowel function.
  
  
  CONCLUSIONS
  Preoperative bladder, bowel, and motor functions, level of sacral tumor involvement, and corresponding level of sacrectomy were the greatest predictors of long-term bladder, bowel, and motor functions. There were no statistically significant changes in bladder, bowel, or motor functions from pre-op to 6 months post-op, and therefore, pre-op functional status was predictive of long-term function.
authors.affiliation: The Johns Hopkins University School of Medicine, 600 N Wolfe St # 6-113, Baltimore, MD 21287, USA.
authors.forename: Dane
authors.initials: D
authors.lastname: Moran
authors.affiliation: The Johns Hopkins University School of Medicine, 600 N Wolfe St # 6-113, Baltimore, MD 21287, USA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Zadnik
authors.affiliation: The Johns Hopkins University School of Medicine, 600 N Wolfe St # 6-113, Baltimore, MD 21287, USA.
authors.forename: Tessa
authors.initials: T
authors.lastname: Taylor
authors.affiliation: The Johns Hopkins University School of Medicine, 600 N Wolfe St # 6-113, Baltimore, MD 21287, USA.
authors.forename: Mari L
authors.initials: ML
authors.lastname: Groves
authors.affiliation: The Johns Hopkins University School of Medicine, 600 N Wolfe St # 6-113, Baltimore, MD 21287, USA.
authors.forename: Alp
authors.initials: A
authors.lastname: Yurter
authors.affiliation: The Johns Hopkins University School of Medicine, 600 N Wolfe St # 6-113, Baltimore, MD 21287, USA.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.affiliation: The Johns Hopkins University School of Medicine, 600 N Wolfe St # 6-113, Baltimore, MD 21287, USA.
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
authors.affiliation: The Johns Hopkins University School of Medicine, 600 N Wolfe St # 6-113, Baltimore, MD 21287, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.affiliation: The Johns Hopkins University School of Medicine, 600 N Wolfe St # 6-113, Baltimore, MD 21287, USA.
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.affiliation: The Johns Hopkins University School of Medicine, 600 N Wolfe St # 6-113, Baltimore, MD 21287, USA. Electronic address: dsciubb1@jhmi.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000209:etiology*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery; D013125:Spinal Neoplasms / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000209:etiology*
keywords: Bladder; Bowel; Chordoma; Sacrectomy; Spine; Surgery; Tumor