Surgical management of the chordomas and chondrosarcomas of the thoracic spine

Chordomas and chondrosarcomas of the spine share several key features that make them distinct from other malignant primary bone tumors. They manifest more indolent behavior characterized by slow but persistent local progression. They are best addressed with aggressive surgical resection, ideally with margins, as radiation and chemotherapy display little efficacy in their treatment. Chordomas can occur anywhere along the axial skeleton and skull base, with relatively equal predilection for skull base, mobile spine, or sacrum. Spinal chondrosarcomas constitute 10% of all chondrosarcomas, with most occurring in the thoracic spine. For both chordoma and chondrosarcoma, en bloc resection should be pursued if technically feasible as it reduces the risk of local recurrence compared to intralesional resection. In cases of suspected spinal chordoma or chondrosarcoma, a computed tomographic-guided core biopsy is recommended to establish the diagnosis, which will allow for subsequent careful interdisciplinary surgical planning. The Enneking and the Weinstein/Boriani/Biagini surgical staging systems can help determine if a patient is a candidate for a wide en bloc resection.