Study Design. En bloc resection of a chordoma in the midcervical vertebral spine was performed.
Objectives. To document the surgical technique used for en bloc excision of a chordoma arising in the midcervical spine.
Summary of Background Data. Malignant tumors arising in long bones are excised en bloc. The authors recently designed a technique for en bloc resection of malignant tumors in the thoracolumbar spine using the T-saw. However, this technique is difficult in tumors of the cervical spine, and there are no previous reports of successful en bloc resection of such tumors.
Methods. Using an anterior approach, the ipsilateral vertebral artery was ligated. This was followed by sharply cutting the pedicle of the cervical vertebra with a specially designed T-saw.
Results. En bloc excision of chordomas in the cervical spine was achieved using the T-saw.
Conclusion. Although the surgical margin was intralesional in a small area, the technique used in this case study indicates that en bloc excision of such tumors can be used with a safety margin even in the cervical spine.
Chordomas are rare primary malignant tumors arising predominantly from the axial skeleton. These tumors traditionally are considered slow-growing, locally invasive neoplasms, constituting between 1% and 4% of malignant bone tumors. There is general agreement that the treatment of choice for chordomas is a complete en bloc surgical resection to prevent contamination by residual tumor cells. 5,6 Recently, the current authors described an innovative surgical technique, termed total en bloc spondylectomy, using a newly designed threadwire T-saw for malignant vertebral tumors in the thoracolumbar spine. 10,11 However, en bloc excision is not feasible in the cervical spine due to the peculiar anatomical complexity of this region including the vertebral arteries as well as the difficulties of cutting the pedicle of the vertebrae using this saw.
This report describes a case in which a chordoma of the cervical spine was managed successfully by en bloc resection using the T-saw. In this article, a full illustrative description of the surgical technique used in the current case is given.