Primary Osseous Chondrosarcoma in the Lumbar Spine: Case Report and Literature Review With Analysis

Abstract

Background Primary spinal chondrosarcoma (CS) is relatively rare, with a reported prevalence rate of less than 10% of all CS. En bloc surgery and resection without entering the tumor capsule typically provides a better prognosis. However, the approaches to such tumor lesions vary. Here, we present a case of CS in the lumbar spine treated with two-stage (anterior and posterior approach) en bloc surgery, along with an analysis and comparison of the characteristics and prognosis of one-stage versus two-stage surgery patients in previous studies. Case description A 30-year-old male with an L3 vertebral body CS presented with back pain and lower limb weakness. Lumbar spine MRI showed an L3 vertebral body tumor with cord and root compression. A two-stage surgery including posterior total laminectomy, transpedicular screw fixation over L2-L4 first with subsequent anterior corpectomy, cage implantation, and anterior lumbar interbody fusion was performed to achieve total tumor removal and stabilization. Pathology revealed a low grade CS with free resection margin. The patient’s symptoms improved after the operation, and no recurrence had occurred as of the two-year follow-up. Furthermore, we also analyzed the post-operative outcomes of 24 cases from previous publications and our current case. Conclusions Two-stage en bloc surgery concomitantly achieves total resection of the tumor, the preservation of neurological function, and a gain in stabilization. The analysis of cases showed that two-stage surgery, in comparison with one-stage surgery, seems to be beneficial in treating L-spine multiple segment disease, providing a lower rate of recurrence.