Chordoma progresses slowly and presents clinically with sacrococcygeal pain, sometimes radiating to the buttocks. Most patients have unilateral or bilateral pain and numbness in the innervated area of the sciatic nerve, and a few patients have a sacrococcygeal mass as the first presentation. Neurogenic tumors, benign peripheral neurogenic tumors include Chewang’s cell tumor (peripheral nerve sheath tumor) and neurofibroma, with a higher incidence of neurofibroma than Chewang’s cell tumor. Neurogenic tumors arising in the sacral region are rare, and most of the sacral neurogenic tumors in the literature are case reports, with approximately 7% of intravertebral neurogenic tumors involving the sacrum. As with chordoma, sacral giant cell tumors are not easily detected in the early stages and only when they grow to a large size do they compress the sacral nerve, manifesting as sciatica and, in severe cases, abnormal bowel and urinary function. The average age of onset of patients with giant cell tumor of bone is 32 years, the youngest of the three common sacral tumors. Combined with its imaging features of mostly eccentric and distending growth, a preliminary diagnosis can be made preoperatively in most cases. The literature reports that giant cell tumors of bone are more common in women, and female patients accounted for 70% of the 26 cases of sacral GCT reported by Turcotte et al. Guo Wei reported a slightly lower 60% of cases in females. Other primary benign tumors of the sacrum teratomas, epidermoid cysts, and dermatomal cysts together accounted for 42.9% of other primary benign tumors of the sacrum, and the remaining benign tumors were less common. Teratomas, epidermoid cysts, and dermatomal cysts are mostly seen in pediatric surgery, and some patients are diagnosed in adulthood due to slow clinical progression. Primary malignant tumors of the sacrum are less common. Chondrosarcomas are most often seen in patients over 30 years of age. Chondrosarcoma of the sacrum accounts for 9.9% of systemic chondrosarcomas . Ewing sarcoma is more common in adolescents, and Ewing sarcoma of the sacrum accounts for 14% of all Ewing sarcomas in the body. Osteogenic sarcoma of the sacrum is rare and accounts for 0.9-1.4% of all osteogenic sarcomas in the body. The higher percentage than reported in the literature may be related to the higher number of sacral tumors treated at our center. Highly malignant sacral tumors tend to be highly symptomatic and progress rapidly. Because they mostly involve the superior sacrum, they often present clinically with severe sciatica, constipation and urinary retention. In younger age, primary malignant tumor of sacrum (including malignant nerve sheath tumor and malignant giant cell tumor of bone) is considered, and in patients over 40 years old, the possibility of metastatic tumor should be considered first. Sacral metastases, most of sacral metastases are given radiotherapy or symptomatic treatment, and fewer patients are admitted to hospital for surgical treatment. Therefore, sacral metastases cannot be considered to account for only 21.1% (94/445) of sacral tumors. Similar to primary malignant sacral tumors, patients with sacral metastases generally have a short history, are symptomatic, and clinically present quickly with abnormal urinary and fecal function. Since they occur mostly in the superior sacral spine, they are prone to concomitant hypotonia of one lower extremity. In addition to the tumor history, the patient’s age is an important factor. Patients with metastases are older than the primary tumor, and bone scans often reveal concurrent bone metastases from other sites. Therefore, patients who present with non-specific clinical manifestations such as lumbosacral pain, lower limb pain and abnormal urinary and fecal functions should be alerted to the possibility of sacral tumors. Although sacral tumors are rare and different sacral tumors have their own clinical characteristics, a correct preliminary diagnosis can be made in most patients by careful clinical analysis based on medical history, physical signs and imaging manifestations. Guo Wei et al. divided the sacrum into superior sacral spine (zone I) and inferior sacral spine (zone II) with the S2/3 intervertebral disc as the boundary; sacral tumors involving the lumbar vertebrae were defined as zone III; the superior sacral spine was divided into anterior (a), lateral (b) and posterior (c) zones with the center of the spinal canal as the boundary. In this group of cases, we found that most of the tumors involving zone II alone were chordoma, teratoma, etc.; tumors involving zone I were mainly myeloma, giant cell tumor of bone, metastatic tumor, etc.; patients with both zone I and II involvement were mostly malignant tumors or giant cell tumor of bone. Sacral tumors involving the lumbar spine (zone III) are mainly recurrent chordoma, highly malignant tumors, and giant cell tumor of bone, etc. Benign neurogenic tumors of the sacrum cannot be treated with this partitioning approach due to their unique extra-sacral growth pattern.