Combined Anterior and Posterior En Bloc Vertebrectomy for Lumbar Chordoma

Abstract

J Korean Neurosurg Soc 45 : [243][244][245] 2009 Chordoma is a rare bone tumor derived from remnants of the notochord. The majority of chordomas involve the sacrum or skull base. We report a rare case of a L4 vertebral body chordoma treated with anterior en bloc vertebrectomy and posterior stabilization. No tumor recurrence was observed at the 5 year follow-up examination.

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].…”

“…Inadequate surgical margins are associated with poor survival and high relapse rates 3. Local tumour progression is a strong prognostic factor for poor survival rates [3,4] 4. Chordomas are resistant against conventional radiotherapy (curative only at toxic doses [60 Gy) and chemotherapy [1].…”

“…In the majority of scenarios, however, margin-free excision is difficult due to surrounding neurovascular structures and extensive tumour size [3,4].…”

“…The combined approach can either be staged or simultaneous with the disadvantage of long operating times. One study comparing staged and simultaneous approaches in 117 patients revealed both methods had similar outcomes and complications with the simultaneous group having shorter operation times by &100 min and greater blood loss of &800 mL [4,7]. Due to the extensive nature of our patient's chordoma, a staged approach was most appropriate.…”

“…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. Consequently, it is uncommon to find chordomas arising from the cervical (10%) or thoracolumbar spine (5%), making our case of an extensive chordoma of the lumbar spine, a rarity [1,3,4]. Our paper focuses on the technical aspects of this unique reconstructive surgery.…”