Surgical Management of Spinal Chordoma: A Systematic Review and Single-Center Experience

World Neurosurg. 2021 Dec:156:e111-e129. doi: 10.1016/j.wneu.2021.09.001. Epub 2021 Sep 22.


Objective: Chordoma is a rare neoplasm of the neuraxis derived from remnants of the primitive notochord. The importance of wide margins and use of adjuvant therapy in spinal chordomas are still contentious points in the management of spinal chordomas. We conducted a systematic review of the surgical management of spinal chordomas alongside our 10-year institutional experience.

Methods: A systematic search of the literature was performed in November 2020 using Embase and MEDLINE for articles regarding the surgical management of chordomas arising from the mobile spine and sacrum. We also searched for all adult patients who were surgically managed for spinal chordomas at our institute between 2010 and 2020. In both the systematic review and our institutional case series, data on adequacy of resection, use of adjuvant therapy, complications, recurrence (local or metastatic), and survival outcomes were collected.

Results: We identified and analyzed 42 articles, yielding 1531 patients, from which the overall gross total or wide resection rate was 54.9%. Among the 8 cases in our institutional experience (4 sacral, 3 cervical, and 1 lumbar), we achieved gross total resection in 50% of initial operations. The recurrence rate was 25% in our gross total resection group and 50% where initial resection was subtotal. Of patients, 75% had no evidence of recurrence at most recent follow-up.

Conclusions: Albeit difficult at times because of the proximity to neurovascular tissue, achieving a wide resection followed by adjuvant therapy for spinal chordomas is of great importance. Multidisciplinary discussion is valuable to ensure the best outcome for the patient.

Keywords: Adjuvant radiotherapy; Chordoma; Sacrum; Spine; Surgical management; Systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Chordoma / diagnostic imaging*
  • Chordoma / radiotherapy
  • Chordoma / surgery*
  • Combined Modality Therapy / methods
  • Disease Management*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Radiotherapy, Adjuvant / methods
  • Retrospective Studies
  • Spinal Neoplasms / diagnostic imaging*
  • Spinal Neoplasms / radiotherapy
  • Spinal Neoplasms / surgery*
  • Treatment Outcome