5-Level Spondylectomy for En Bloc Resection of Thoracic Chordoma

Abstract

Primary tumors of the spine are considered for en bloc resection to improve local control and even obtain cure. Anatomic restrictions often prohibit extensive resections with negative margins that are safe and feasible. We report the first case involving a patient with a large chordoma of the thoracic spine who underwent a successful 5-level spondylectomy with bilateral chest wall resection for en bloc resection without neurologic compromise. A 26-year-old woman with a chest mass was found to have a T1-5 chordoma via a percutaneous biopsy. En bloc resection of the mass was thought to be the best option for long-term local control and possible cure. She presented without neurologic or pulmonary dysfunction. The patient underwent a 3-stage procedure. The first stage involved a posterior C2-T8 exposure, allowing release of posterior elements from C7 to T6 and instrumented stabilization from C2 to T8. T1-5 ribs were cut bilaterally, and 2 wire saws were placed ventral to the thecal sac at the C7-T1 and T5-6 disc levels. The second stage involved a right-sided thoracotomy, and the T5-6 wire saw was used to complete the lower osteotomy. The third stage involved completion of the C7-T1 osteotomy with the wire saw, delivery of the tumor specimen en bloc, ventral reconstruction of the spine with a titanium mesh cage, and bilateral thoracoplasty. This is the first case report of a 5-level spondylectomy for en bloc resection of an extensive thoracic chordoma via a bilateral thoractomy without neurologic compromise.