Surgical treatment of primary tumors of the sacrum.

Fifty-four patients were surgically treated for primary tumors of the sacrum. The ratio of men to women was 2:1, and most patients were from 30-50 years of age. Nearly half the tumors were chordomas, and the others were mostly giant cell tumors and neurofibromas. Proven malignancy was present in less than 10%. The operative and postoperative mortality was 11%, wound infection 11%, delayed wound healing 11%, and the immediate success rate 89%. A follow-up study of 33 cases for more than two years showed that 25 patients were living and well, providing a survival rate of 75.7%. Except for malignant tumors, preservation of upper sacral nerve roots was possible and necessary in the majority of low grade and benign tumors. Ligation of both internal iliac arteries and a temporary block of the common iliac arteries or aorta minimized bleeding. Injury to veins must be carefully avoided. Postoperative X-ray treatment appeared helpful in reducing recurrences, especially in upper sacral tumors where nerve root compression had to be relieved.

EAR method: an alternative method of bone grafting following bone tumor resection (a preliminary report).

The EAR (Excision, Alcoholization, Replantation) method consists of a proper tumor resection, removal of tumor tissue extracorporally, soaking the residual bone shell in 95% alcohol for half an hour, and replantation in situ, the cavity being filled with bone graft or bone cement. Eighty-three cases were treated in this manner, of which 95% were followed for 2 years or more, with complete success in cases with IA lesions and no recurrence in two-thirds of those with IB-IIB lesions. Experimentally, it is proved that alcohol can kill tumor cells completely without interfering with osteogenesis. The joint cartilage, although degenerated, is replaced by newly formed fibrocartilage, thus preserving joint function.