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Four-Level Vertebrectomy For En Bloc Resection of a Cervical Chordoma: Technical Case Report.

Research paper by Salah G SG Aoun, Mahmoud M Elguindy, Umaru U Barrie, Tarek Y TY El Ahmadieh, Aaron A Plitt, Jessica R JR Moreno, John M JM Truelson, Carlos A CA Bagley

Indexed on: 31 Jul '18Published on: 31 Jul '18Published in: World Neurosurgery



Abstract

Chordomas are locally aggressive tumors that can involve multiple levels of the spine and are difficult to resect. We present our technique for a 4-level en bloc cervical spondylectomy for a locally aggressive chordoma METHODS: A 37 year-old woman presented with 6 months of dysphagia and a large indurated cervical mass. Her imaging revealed an enhancing lesion involving the vertebral bodies of C3 to C6. Needle biopsy confirmed the diagnosis of chordoma. We opted for en bloc resection to maximize her chances of disease-free survival. A 360 approach was deemed necessary. We started by posteriorly disconnecting the vertebral bodies and skeletonizing the bilateral vertebral arteries and nerve roots. The interspinous and yellow ligaments and the spinous processes were spared to maintain a solid posterior tension band, as previously described approaches that had sacrificed these elements had a high rate of instrumentation failure. After posterior instrumentation, a wide anterior approach allowed us to resect the tumor attached to the vertebral bodies of C3 to C6 as one specimen. A 4-level corpectomy cage and plate were used to instrument the spine anteriorly. The patient tolerated the surgery well. She needed a temporary gastrostomy. She had a right C5 palsy that progressively recovered. Her follow-up imaging showed no tumor recurrence and good bony fusion. En bloc resection as part of a multidisciplinary team approach remains the mainstay of spinal chordoma treatment. Modern instrumentation and careful dissection can allow for good results even in locally advanced cases. Copyright © 2018 Elsevier Inc. All rights reserved.