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My sister's husband was diagnosed with osteosarcoma of the sacrum. They are actually going to remove half of the bone in order to get the entire tumor. Nobody has brought it up, but we can't help but wonder: will he be able to walk again?

Tumors of the sacrum are rare but can create serious problems. They can be benign or malignant. They may be primary, which means they develop first right in the sacrum. Osteosarcoma of the sacrum is a primary bone tumor. It didn't metastasize from someplace else to the sacrum -- it started right in the bone. Surgery to remove the tumor isn't always possible right away. The tumor can be too large or too enmeshed with other structures to remove it easily. Radiation may be used first to shrink as much of the tumor as possible. Tumors that are advanced by the time they are diagnosed make surgery difficult and complex. Removing the tumor, a procedure called resection, isn't always a straightforward process. The anatomy of the pelvic and sacral areas is a challenge. Bowel, bladder, and sexual function are easily disrupted by any changes in this area. The patient's preoperative health can also make a difference (e.g., diabetes, high blood pressure, heart disease). For those patients who can have surgery, multiple procedures may be needed to reconstruct vital bowel and bladder structures. Removal of the entire sacrum (called sacrectomy) can be a major undertaking, especially if the sacroiliac joints are compromised by the tumor. This anatomical area provides support, stability, and biomechanical function for the entire lower body. It sounds like your brother-in-law is scheduled for a hemi-sacrectomy (removal of half the sacrum). Most likely, the surgeon won't just take the bone out and leave the patient with half a sacrum. Usually for such a large area removed, bone from a bone bank is transplanted to replace the missing piece. Sometimes metal plates, screws, or pins are needed to hold everything together until the bone can fuse itself in place. Patients can regain walking skills again. In fact, studies show that between 57 and 84 per cent of patients who have sacral amputation followed by radiation therapy are able to get up and walk again. There is a long period of recovery and rehab before this can be accomplished.

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