{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:24:45Z","timestamp":1791811485095,"version":"4.3.4"},"reference-count":58,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Wide en bloc excision of sacrococcygeal chordomas often requires sacral nerve root sacrifice because of their large size and involvement of surrounding structures. In this study, the authors characterize the long-term functional outcomes of patients following definitive resection, investigate the relationship between sacrificed nerve roots and deficits, and examine predictors of postoperative neurological deficits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective study was conducted on all patients followed for sacral chordoma management at a quaternary spinal oncology center from 2003 to 2023. Data on patient demographics, clinical characteristics, pre- and perioperative treatment, and symptoms at last follow-up were collected. Nerve root sacrifices were documented and, where unilateral ligations were performed, the highest level of bilateral sacrifice was noted. The primary outcomes were pain, weakness, bowel or bladder dysfunction (BBD), and sensory deficits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Sixty-six patients were included, with a median follow-up of 5.8 (interquartile range [IQR] 3.0\u20138.5) years. The proportion of pain-free patients increased from 22.7% preoperatively to 54.5% after surgery, and a majority experienced improvement in pain (88.2%) and sensory deficits (83.3%). All patients who had bilateral sacrifices up to the S1\u20132 nerve roots and 92.9% with up to S3 bilateral nerve root sacrifice had BBD. However, motor deficits were observed in only 60.0% of those with S1 nerve root sacrifice. Additionally, 13.6% of patients had unexpected BBD and motor weakness at last follow-up. Multivariable analysis demonstrated surgical duration (odds ratio [OR] 1.003, 95% confidence interval [CI] 1.001\u20131.006; p = 0.020), tumor volume (OR 1.002, 95% CI 1.000\u20131.004; p = 0.017), and preoperative weakness (OR 37.0, 95% CI 1.3\u20131072.9; p = 0.036) were related to postoperative weakness. Only expected BBD due to nerve root sacrifice (OR 28.5, 95% CI 3.0\u2013267.9; p = 0.002) was associated with postoperative BBD. Finally, preoperative sensory deficits (OR 6.6, 95% CI 1.2\u201336.4; p = 0.031) and surgical duration (OR 1.004, 95% CI 1.001\u20131.007; p = 0.003) were predictive of postoperative sensory deficits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>En bloc excisions of sacrococcygeal chordomas require complex approaches in which surgeons must consider the long-term functional effects of nerve root sacrifice. These results provide insight into residual function following these extensive operations and suggest that preserving the S3 nerve roots is critical in minimizing BBD. Cases in which the S3 is preserved but patients continue exhibiting postoperative BBD may be related to larger tumor size and intraoperative manipulation of distal S1\u20133 nerves or pudendal nerves. When S1 roots are preserved, larger tumor size may predict motor weakness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.3.spine241408","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T14:34:40Z","timestamp":1757687680000},"page":"481-488","source":"Crossref","is-referenced-by-count":4,"title":["Long-term functional outcomes and their relationship to nerve root sacrifice after definitive surgery for sacrococcygeal chordoma"],"prefix":"10.3171","volume":"43","author":[{"given":"Yuanxuan","family":"Xia","sequence":"first","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pritika","family":"Papali","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdel-Hameed","family":"Al-Mistarehi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Karim","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Landon J.","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Meyer","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, and Departments of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Gross","sequence":"additional","affiliation":[{"name":"Pathology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majid","family":"Khan","sequence":"additional","affiliation":[{"name":"Radiology and Radiological Science, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malcolm","family":"Winkle","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chetan","family":"Bettegowda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Witham","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Theodore","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Paul","family":"Wolinsky","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Northwestern University, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziya","family":"Gokaslan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Fu Larry","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zucker School of Medicine at Hofstra, Manhasset, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Sciubba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zucker School of Medicine at Hofstra, Manhasset, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salih","family":"Colakoglu","sequence":"additional","affiliation":[{"name":"Departments of Plastic Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang H.","family":"Lee","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin J.","family":"Redmond","sequence":"additional","affiliation":[{"name":"Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lubelski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Global Spine J","first-page":"740","article-title":"Outcomes of surgery for sacral chordoma and impact of complications: a report of 50 consecutive patients with long-term follow-up","volume":"11","author":"Zuckerman SL","year":"2021","unstructured":"Zuckerman SL, Lee SH, Chang GJ,  Outcomes of surgery for sacral chordoma and impact of complications: a report of 50 consecutive patients with long-term follow-up. 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