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  • Surgical Interventions and Associated Outcomes of Primary Chondrosarcoma of the Spine

    Final Number:
    1136

    Authors:
    Kristen N Kaiser BS; Peyton Lubbock Nisson BS; Garrett Kenneth Berger BS; Whitney S. James; R. John Hurlbert MD, PhD, FACS, FRCS(C)

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Chondrosarcoma (CS) of the spine is a difficult lesion to treat given its invasive nature and proximity to the spinal cord. To date, only a limited number of case reports and case series exist reporting on these tumors.1-5 Investigators seek to gain a better understanding of this patient population and the types of surgical techniques used for treatment.

    Methods: A systematic literature search was performed in January 2018 querying several scientific databases, per PRISMA guidelines. Inclusion criteria specified all studies and case reports of patients with CS located in the spine for which all possible therapies, including spinal surgery, were considered and applied. Studies with other sarcoma subtypes, non-human populations, and no reported patient outcomes were excluded from the focused review. Surgery type was categorized into either en bloc, spondylectomy, or ‘other.’ Neurologic status was assessed using the modified Rankin Score (mRS); outcomes following surgery were dichotomized as either ‘good’ (mRS 0-2) and poor (mRS 3-6).

    Results: In total 28 records were included in the review yielding 48 patients with primary chondrosarcoma of the spine. The mean age was 36.0 years (Range 1-70), with the tumor most commonly arising in adult patients (n=39, 81.3%), the majority of which were males (75%). En bloc (n=20, 41.7%) was most common surgical method used, followed by spondylectomy (n=13, 27.1). Patients who underwent spondylectomy exhibited the highest death rate (n=6, 46.2%, p=.017) and highest rate of recurrence (n=7, 53.8%, p=.026) compared to en bloc and other types of surgery. Of the 35 patients with a mRS scores available, 20 were recorded as ‘good’ outcomes (57.1%).

    Conclusions: CS is a rare lesion that most commonly presents in adult, male patients. En bloc resection was used in most of the cases and spondylectomies were associated with a significantly higher rate of mortality and recurrence than other surgical treatments.

    Patient Care: CS is a rare lesion that most commonly presents in adult, male patients. En bloc resection was used in the majority of the cases examined and spondylectomies were associated with a significantly higher rate of mortality and recurrence than other surgical treatments. Further, of the 35 patients with mRS scores available, 20 were recorded as a ‘good’ outcomes (57.1%). With this information, neurosurgeons will have more information regarding morbidity, mortality, and quality of life in choosing a surgical approach. Additionally, they will be able to better inform their patients on what to expect following surgical intervention.

    Learning Objectives: 1. CS is a rare lesion that most commonly presents in adult, male patients. 2. En bloc resection was used in the majority of the cases examined and spondylectomies were associated with a significantly higher rate of mortality and recurrence than other surgical treatments. 3. Of the 35 patients with mRS scores available, 20 were recorded as 'good' outcomes (57.1%).

    References: 1. Dreghorn CR, Newman RJ, Hardy GJ, Dickson RA. Primary tumors of the axial skeleton. Experience of the Leeds Regional Bone Tumor Registry. Spine. Feb 1990;15(2):137-140. 2. Flemming DJ, Murphey MD, Carmichael BB, Bernard SA. Primary tumors of the spine. Seminars in musculoskeletal radiology. 2000;4(3):299-320. 3. Boriani S, De Iure F, Bandiera S, et al. Chondrosarcoma of the mobile spine: report on 22 cases. Spine. Apr 01 2000;25(7):804-812. 4. Ropper AE, Cahill KS, Hanna JW, et al. Primary vertebral tumors. Neurosurgery 2012;70:211 – 9. 5. Strike, Sophia A, and Edward F McCarthy. Chondrosarcoma of the spine: a series of 16 cases and a review of the literature. The Iowa Orthopaedic Journal 31 (2011): 154–159. Print.

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