Four-Level Vertebrectomy for En Bloc Resection of a Cervical Chordoma

Salah G. Aoun, Mahmoud Elguindy, Umaru Barrie, Tarek Y. El Ahmadieh, Aaron Plitt, Jessica R. Moreno, John M. Truelson, Carlos A. Bagley

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Chordomas are locally aggressive tumors that can involve multiple levels of the spine and are difficult to resect. We present our technique for 4-level en bloc cervical spondylectomy for a locally aggressive chordoma. Case Description: A 37-year-old woman presented with a 6-month history of dysphagia and a large indurated cervical mass. Imaging showed an enhancing lesion involving C3-6. Needle biopsy confirmed the diagnosis of chordoma. En bloc resection was chosen to maximize her chances of disease-free survival. A 360° approach was deemed necessary. We posteriorly disconnected the vertebral bodies and skeletonized 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 enabled us to resect the tumor attached to the vertebral bodies of C3-6 as 1 specimen. A 4-level corpectomy cage and plate were used for anterior instrumentation. The patient tolerated the surgery well. She needed a temporary gastrostomy, and she had a right C5 palsy that progressively recovered. Follow-up imaging showed no tumor recurrence and good bony fusion. Conclusions: En bloc resection as part of a multidisciplinary team approach remains the mainstay of spinal chordoma treatment. Modern instrumentation and careful dissection can provide good results even in locally advanced cases.

Original languageEnglish (US)
Pages (from-to)316-323
Number of pages8
JournalWorld Neurosurgery
Volume118
DOIs
StatePublished - Oct 1 2018

Fingerprint

Chordoma
Neoplasms
Gastrostomy
Vertebral Artery
Needle Biopsy
Deglutition Disorders
Ligaments
Paralysis
Disease-Free Survival
Dissection
Spine
Recurrence

Keywords

  • Cervical spine tumor
  • Chordoma
  • En bloc resection
  • Posterior tension band
  • Spine reconstruction
  • Spondylectomy
  • Technique

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Aoun, S. G., Elguindy, M., Barrie, U., El Ahmadieh, T. Y., Plitt, A., Moreno, J. R., ... Bagley, C. A. (2018). Four-Level Vertebrectomy for En Bloc Resection of a Cervical Chordoma. World Neurosurgery, 118, 316-323. https://doi.org/10.1016/j.wneu.2018.07.153

Four-Level Vertebrectomy for En Bloc Resection of a Cervical Chordoma. / Aoun, Salah G.; Elguindy, Mahmoud; Barrie, Umaru; El Ahmadieh, Tarek Y.; Plitt, Aaron; Moreno, Jessica R.; Truelson, John M.; Bagley, Carlos A.

In: World Neurosurgery, Vol. 118, 01.10.2018, p. 316-323.

Research output: Contribution to journalArticle

Aoun, SG, Elguindy, M, Barrie, U, El Ahmadieh, TY, Plitt, A, Moreno, JR, Truelson, JM & Bagley, CA 2018, 'Four-Level Vertebrectomy for En Bloc Resection of a Cervical Chordoma', World Neurosurgery, vol. 118, pp. 316-323. https://doi.org/10.1016/j.wneu.2018.07.153
Aoun SG, Elguindy M, Barrie U, El Ahmadieh TY, Plitt A, Moreno JR et al. Four-Level Vertebrectomy for En Bloc Resection of a Cervical Chordoma. World Neurosurgery. 2018 Oct 1;118:316-323. https://doi.org/10.1016/j.wneu.2018.07.153
Aoun, Salah G. ; Elguindy, Mahmoud ; Barrie, Umaru ; El Ahmadieh, Tarek Y. ; Plitt, Aaron ; Moreno, Jessica R. ; Truelson, John M. ; Bagley, Carlos A. / Four-Level Vertebrectomy for En Bloc Resection of a Cervical Chordoma. In: World Neurosurgery. 2018 ; Vol. 118. pp. 316-323.
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abstract = "Background: Chordomas are locally aggressive tumors that can involve multiple levels of the spine and are difficult to resect. We present our technique for 4-level en bloc cervical spondylectomy for a locally aggressive chordoma. Case Description: A 37-year-old woman presented with a 6-month history of dysphagia and a large indurated cervical mass. Imaging showed an enhancing lesion involving C3-6. Needle biopsy confirmed the diagnosis of chordoma. En bloc resection was chosen to maximize her chances of disease-free survival. A 360° approach was deemed necessary. We posteriorly disconnected the vertebral bodies and skeletonized 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 enabled us to resect the tumor attached to the vertebral bodies of C3-6 as 1 specimen. A 4-level corpectomy cage and plate were used for anterior instrumentation. The patient tolerated the surgery well. She needed a temporary gastrostomy, and she had a right C5 palsy that progressively recovered. Follow-up imaging showed no tumor recurrence and good bony fusion. Conclusions: En bloc resection as part of a multidisciplinary team approach remains the mainstay of spinal chordoma treatment. Modern instrumentation and careful dissection can provide good results even in locally advanced cases.",
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