Chordoma of the lumbar spine: a case report

Abstract

Chordomas are rare tumors and they may arise anywhere along the spinal column and clival bone. The vast majority of tumors are found at skull base and sacrum. Chordomas involving the lumbar spine are rare. Approximately 6% of spinal chordomas originate in the lumbar vertebrae. We report a case of this chordoma arising from the lumbar vertebra.

Extensive lumbar chordoma and unique reconstructive approach

“…The site and size of a chordoma impacts greatly on the outcome, with those arising from the vertebrae being more likely than other chordomas to be locally aggressive, metastasize (80 vs. 43%) and have low 5YSR. Lumbar chordomas like our patient have higher metastatic rates than in any other location [2][3][4][5], however, local aggressiveness rather than metastases is more likely to cause death and disability [5].…”

“…They are most commonly found in middle to older-aged adults with an incidence of\1/1,000,000 per year, accounting for\5% of primary spinal bone tumours [1,2]. Although chordomas may appear anywhere along the spinal axis, most arise at the sacrum (50-60%) or skull-base (25-35%), consistent with the theory that they form from the notochord.…”

“…The most frequent complaint in those with lumbar chordomas is pain and paraesthesia. Motor changes can occur, however, paraplegia is rare [2]. Our patient complained of 3 years of back pain and 3 months of neurogenic claudication.…”

“…Chordomas are primary bone tumours arising from the notochord remnant characterised by slow growth over years, often metastasising late in 40-60% to the lung, bone, soft tissue, liver, skin or lymph nodes [1,2]. The 5-year survival rate (5YSR) is 50% while the 10-year survival rate (10YSR) is 28% [5].…”

“…Pre-operative diagnosis of lumbar chordomas is also difficult as they are often confused for more common lumbar spine tumours, including a giant cell tumour, myeloma, metastasis, haemangioma and aneurismal bone cyst [2]. Currently, MRI is the preferred imaging modality for preoperative diagnosis and assessment.…”