Multilevel Lumbar En-bloc Vertebrectomy for Chordoma

Abstract

Objective: To demonstrate that total en bloc removal of chordoma involving multiple vertebrae of the lumbar spine is achievable, using a technique previously described for single level tumors. It is a technically demanding procedure which requires careful planning. We also show that femoral or tibial allograft provides a strong and cheaper alternative to modern cages and should be considered for anterior reconstruction in these cases.

Methods: We describe in detail the technique used in a patient who presented with a lumbar chordoma extending over three vertebral bodies, L3 to L5, which in addition had expanded bilaterally into the paravertebral region. The initial reconstruction failed as the intervertebral cage dislocated. We revised this with tibial allograft and obtained a solid construct this way.

Results: Complete en bloc excision and stable reconstruction was ultimately achieved despite the difficulties we encountered. At five years the patient remained disease free.

Conclusions: En bloc resection of chordoma involving multiple lumbar vertebrae is feasible. The technique described may be used for other tumors involving the lumbar spine, perhaps even in cases where more than three levels are involved. Tibial or femoral allograft provides a better and cheaper alternative to cages and can be useful when resources are scarce.