En bloc excisions of chordomas in the cervical spine: Review of five consecutive cases with more than 4-year follow-up

Study Design: Retrospective case series of five consecutive patients. Objective: To determine the oncological outcomes and morbidity rates after en bloc excisions of cervical chordomas. Summary of Background Data: Studies have demonstrated that en bloc surgical excision of chordoma with negative margins results in improved local disease control and survival compared with intralesional resections. Chordomas arising from the cervical spine are rare and they present unique challenges for en bloc tumor excision. We present a series of five consecutive cases of cervical chordoma managed with en bloc tumor excision, which represents one of the largest surgical experiences of cervical chordomas reported to date. Methods: A retrospective review of our institutional spine tumor database identified five consecutive patients who underwent en bloc tumor excision for cervical spine chordoma from 2000 to 2007. We analyze their surgical margins, perioperative complications, tumor recurrence rate, and survival. Results: Our review demonstrated that dysphagia and cervicalgia were the most common presenting symptoms for cervical chordoma. The mean age of diagnosis in this cohort was 52.4 years and our mean follow-up is 54.7 months. All five patients required multistage procedures to achieve en bloc tumor excision. Independent analysis of the surgical margins by the pathologists revealed that marginal en bloc excisions were achieved in all five patients. Our 30-day perioperative complication was significant for one case of transient radiculopathy with paresis and one wound infection. Other long-term complications included three cases with pseudoarthrosis with instrumentation failures requiring surgical revisions. There were no neurological or cerebrovascular complications. The mean disease-free survival after en bloc spondylectomy for cervical chordoma was 84.2 months in this cohort. Conclusion: En bloc excision of chordoma, whether wide or marginal, is the most ideal for treatment to prolong disease-free survival. En bloc excisions of chordomas in the cervical spine are technically complex procedures but can be performed with acceptable safety and perioperative morbidity.