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J Neurosurg Spine. 2016 Apr;24(4):644-51. doi: 10.3171/2015.7.SPINE15201. Epub 2015 Dec 18.

Mobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database.

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Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
Research Department, AOSpine International, Davos, Switzerland;
Section for Oncological Orthopaedics and Reconstruction of the Spine, IRCCS Istituto Orthopedico Galeazzi, Milan, Italy;
Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas;
Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada;
National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary;
Department of Orthopaedic Surgery, The CORE Institute, Sun City West, Arizona;
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;
Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada;
Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom;
Department of Neurological Surgery, University of California San Francisco, California;
Spinal Division, Nuffield Orthopedic Centre, University of Oxford, United Kingdom;
Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia;
Department of Orthopedic Surgery, Kanazawa University, Kanazawa, Japan; and.
Department of Oncologic and Degenerative Spine Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy.



A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosis-predicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI.


Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling.


A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41%) patients were EA and 84 (59%) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35%) patients developed local recurrence and 57 (34%) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95% CI 2.96-16.6; p < 0.001), although no significant difference in survival was observed.


EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.


EA = Enneking appropriate; EI = Enneking inappropriate; Enneking classification; chordoma; mobile spine; oncology; recurrence; surgery; survival; tumor

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