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Three-Level En Bloc Spondylectomy for Chordoma

Clarke, Michelle J MD*; Hsu, Wesley MD‡; Suk, Ian BSc, MBC‡; McCarthy, Edward MD§; Black, James H III MD; Sciubba, Daniel M MD‡; Bydon, Ali MD‡; Yassari, Reza MD‡; Witham, Timothy F MD‡; Gokaslan, Ziya L MD‡; Wolinsky, Jean-Paul MD‡

doi: 10.1227/NEU.0b013e31821348c9
Operative Technique
CNS University of Neurosurgery

BACKGROUND: En bloc resection of spinal and sacral chordomas may convey a survival benefit. However, these procedures often are complex and require the surgeon to plan a procedure that results in negative tumor margins, protects vital neurovascular structures, and concludes with a viable biomechanical reconstruction.

OBJECTIVE: We present a case of a 3-level en bloc lumbar spondylectomy and reconstruction.

METHODS: A case of a 45-year-old woman with biopsy-proven exophytic L4 chordoma is presented. The patient underwent successful L3-L5 en bloc spondylectomy and reconstruction over 3 stages.

RESULTS: The patient did well following the procedure, and was neurologically intact at 6-week follow-up.

CONCLUSION: Three-level en bloc spondylectomy with lumbopelvic reconstruction is a challenging yet feasible procedure.

*Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; ‡Department of Neurosurgery, §Department of Pathology, ¶Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland

Received, April 15, 2010.

Accepted, October 21, 2010.

Correspondence: Jean-Paul Wolinsky, MD, Department of Neurosurgery, Johns Hopkins University, 600 Wolfe Street, Meyer 7-109, Baltimore, MD 21287. E-mail:

Copyright © by the Congress of Neurological Surgeons