LATE PRESENTATION OF TWO RARE SACRAL SPINE TUMORS CHALLENGES OF DIAGNOSIS AND TREATMENT IN A LOW RESOURCE SETTING

Abstract

Lower back pain with or without an associated mass should be examined thoroughly by physical examination aided with radiological imaging. Described here are two young male adults; 29 and 30 years of age with lower back pain associated with lumbar masses. These patients initially treated themselves with herbal preparations without success. Diagnoses of chordoma and myxopapillary ependymoma were made in the 29 and 30-year old patients respectively after physical examination and imaging. These diagnoses were confirmed by histopathological investigation. Both patients requested discharge against medical advice. Unfortunately, they died at home within one month after discharge. The diagnosis of chordoma and myxopapillary ependymoma can be very challenging and requires a multidisciplinary approach involving a radiologist, pathologist, oncologist and an orthopedic surgeon. The poor outcomes in both patients could be attributed to ignorance, entrenched cultural beliefs, late diagnosis from low index of suspicion and lack of requisite diagnostic tools. This indicates that patients are still dying of treatable conditions in low- and middle-income countries especially in Africa. We propose awareness creation among clinicians, and a fund to be established both locally and globally to help with the diagnosis and treatment of sacral tumors.