Chondrosarcoma of the thoracic spine in an 8-year-old child with 12 years follow-up: A case report

One-stage En bloc resection of thoracic spinal chondrosarcoma with huge paravertebral mass through the single posterior approach by dissociate longissimus thoracis

Study design

Retrospective case series.

Objective

To describe the technique details and therapeutic outcomes of 3-D printing model-guided en bloc resection of chondrosarcoma (CHS) with huge paravertebral mass via the combined posterior median and Wiltse approach.

Summary of background data

Total en bloc spondylectomy (TES) technique is conventionally based on the single posterior approach or combined anterior-posterior approach. However, the single posterior approach imposes a high technical demand on the surgeon due to the narrow field of vision, limited surgical space and the delicate spinal cord, while the combined anterior-posterior approach not only requires greater patient tolerance but is time consuming and runs the risk of more blood loss and injury to the visceral pleura and large blood vessels during surgery. In addition, it is difficult to completely remove the thoracic CHS with paravertebral mass through simple en bloc resection when it involves the aorta, vena cava, costa and lung.

Material and methods

Between August 2010 and January 2016, we performed a retrospective study to evaluate the clinical characteristics and outcomes of en bloc resection of thoracic spinal CHS with paravertebral mass through the combined posterior median and Wiltse approach. Postoperative recurrence-free survival (RFS) and overall survival (OS) were estimated by the Kaplan-Meier method. P values less than 0.05 were considered statistically significant.

Results

Altogether 15 patients received en bloc resection of thoracic spinal CHS with paravertebral mass through the combined posterior median and Wiltse approach. The mean age of these patients was 37.0 ± 12.8 years (median 36; range 15–64). This combination approach provided more extensive exposure and wider marginal resection of the tumor within a mean operation duration of 288 ± 96 min (median 280; range 140–480) and mean intraoperative blood loss of 1,966 ± 830 ml (median 2,000; range 300–3,000). Of the 15 patients, 5 experienced local recurrence of the disease; the mean time from surgery to recurrence was 22 ± 9.85 months (median 17, range 13–35). RFS in patients with recurrent CHS was significantly lower than that in patients with primary CHS on admission (p = 0.05).

Conclusions

The combined posterior median and Wiltse approach is a technically viable option for en bloc resection of thoracic spinal CHS with huge paravertebral mass, and can give a favorable local control of CHS.

Level of evidence

Level V.

A Rare and Interesting Case of a Massive Secondary Spinal Chondrosarcoma and Review of the Literature

Chondrosarcoma, the second most common primary malignancy of the bone, is malignant cartilage forming tumour that very rarely involves the axial skeleton. It may arise as a primary bone tumour or as a secondary lesion from a preexisting benign cartilaginous neoplasm such as osteochondroma or enchondroma. A rare case of a massive secondary lumbar spine chondrosarcoma is presented. Management consisted of an initial posterior spinal stabilization and fusion and then a curative radical en bloc tumour resection. A review of the literature is also presented.

Total excision of a recurrent chondrosarcoma of the thoracic spine: a case report of a seven-year-old boy with fifteen years follow-up

STUDY DESIGN

A case report is presented.

OBJECTIVE

To describe the surgical procedure for removal of the recurrent tumor.

SUMMARY OF BACKGROUND DATA

Marginal or wide en bloc excision for recurrent chondrosarcoma is extremely difficult because of the postsurgical adhesion with surrounding soft tissues such as the dural tube.

METHOD

This case report includes a chart review, an examination of the patient, and a literature search. RESULTS.: A 7-year-old boy had difficulty with ambulation because of a tumor recurrence 18 months after posterior curettage of the primary chondrosarcoma of the T6 and T7. The spinal cord was severely compressed by the epidural mass, which was located anterior and to the left side of the spinal canal. The epidural tumor including the tumor capsule on the left side of the dural tube was excised piecemeal fashion. En bloc corpectomy of T6 and T7 including the capsulated epidural tumor that was located ventrally to the spinal cord was performed. A fresh iliac crest strut allograft from the patient's father was grafted to the anterior defect, and in addition, H-shape allograft was placed over the posterior side. At 15-year follow-up, the patient is ambulating with the aid of a cane, and there is no sign of recurrence on computed tomography scan or magnetic resonance imaging. His spinal alignment was maintained.

CONCLUSION

Total excision (en bloc corpectomy with partially piecemeal removal) including the tumor margin has given local control and survival for 15 years in this patient who had recurrent chondrosarcoma. Anteroposterior biologic spinal reconstruction has maintained spinal alignment.

Low grade central chondrosarcoma of the fifth costotransverse joint

Chondrosarcoma (CHS) is the third most frequent primary malignant tumour of bone exceeded only by myeloma and osteosarcoma. It usually occurs in the trunk bones (pelvic girdle, shoulder, ribs) followed by the femur and humerus and is very rare in the spine accounting for about 5% of all CHSs. The majority of patients affected are over 50 years old. We report a case of a 22-year-old woman with a 2-month history of pain on the right side of the upper thoracic spine. Complete imaging work-up with radiographs, CT, MRI and digital subtraction angiography showed an osteolytic lesion of the right transverse process of T5 with extension into the ipsilateral rib and enhancing extracompartmental tissue involving the paraspinal muscles. Both CT-guided core needle biopsy and excisional biopsy were consistent with grade I central CHS with myxoid change and focal areas of Grade II CHS.