Sacral Chordoma Presenting as Back Pain in the Chiropractic Clinic: A Case Report

Abstract

Cases of lumbar and gluteal pain are commonly encountered in chiropractic clinics, with a broad differential diagnosis primarily centered on musculoskeletal conditions. This report presents the second documented case of sacral chordoma diagnosed at a chiropractic clinic and emphasizes the importance of considering alternative diagnoses and interdisciplinary collaboration in patient care. A 42-year-old man presented to a chiropractic clinic with complaints of lumbar and gluteal pain. The initial conservative management based on a presumptive musculoskeletal diagnosis was ineffective. Suspicion of an alternative etiology prompted a referral for imaging, which revealed a sacral chordoma. An interdisciplinary collaboration involving orthopedic surgeons, oncologists, radiologists, and other healthcare professionals was initiated to optimize the treatment outcomes of this rare and aggressive tumor. This case report underscores the importance of maintaining a high index of suspicion in cases of musculoskeletal presentations in chiropractic clinics and the critical role of advanced imaging in establishing a definitive diagnosis. Interdisciplinary collaboration is essential for managing complex conditions such as sacral chordomas, ensuring the delivery of the highest quality of care, and optimizing patient outcomes. Chiropractors play a crucial role in identifying, referring, and contributing to the management of patients with complex presentations as part of a comprehensive multidisciplinary treatment plan.

Keywords: back pain; chiropractic; chiropractor; gluteal pain; lumbar pain; sacral chordoma.

Figure 1. Lumbar radiographs.

An expansile lytic lesion is identified at the sacrum (white arrow) in both (A) anterior-posterior and (B) lateral views of the lumbar radiographs.

Figure 2. Lumbar magnetic resonance image (MRI): The presence of a moderately hypermetabolic soft tissue mass involving S1-S3 vertebral bodies with a presacral soft tissue component and measuring 6.96 × 5.12 cm (white arrow) strongly suggests a malignant process.

(A) On T2-weighted images, high signal intensity can be seen. Destruction or erosion of the sacral bone, and possible extension into adjacent structures, can also be identified. (B) On T1-weighted images, the image appears isointense compared to the normal spinal cord. (C) On the coronal view, destruction or erosion of the sacral bone can be seen.

Figure 3. Whole-body positron emission tomography-computed tomography (PET-CT) excluding the brain.

A presacral soft tissue component and a moderately hypermetabolic soft tissue mass (circle) involving the S1–S3 vertebral bodies can be observed (SUVmax: 6.16) at the coronal (A), lateral (B) and anterior-posterior views (C), which is strongly suggestive of a malignant process.