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Chordomas of the mobile : Mobile Spine and spine and sacrum

•Goal – Cure/Long Term Survival Jean-Paul Wolinsky, M.D. •Adjuvant Therapy – Limited

• – Limited •Surgical Technique – En bloc

Boriani S, Bandiera S, Biagini R, Bacchini P, Boriani L, cappuccio M, Chevalley F, Gasbarrini A, Picci P, Weinstein JN. Chordoma of the Mobile Spine: Fifty Years of Experience. Spine. 2006; 31(4): 493-503.

Oncological and clinical outcomes following attempted en bloc sacrectomy with judicious Definition of Terms sacral nerve root preservation for primary malignant sacral tumors. Spine Spondylectomy

Sacrectomy/ Sacral Amputation

En Bloc - Wide - Marginal - Planned Transgression*

Intralesional

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Surgical Approaches

Understanding Sacrifice: • Vertebral Artery • Segmental Arteries • Nerve Roots – Bilateral hypoglossal nerve injury can result in inability to eat or speak – Bilateral C3-C5 function required for Phrenic nerve function – Unilateral sacrifice of C5-T1 results in significant morbidity – T2-L1 can be sacrificed with minimal consequence – Unilateral sacrifice of L2-L5 results in significant morbidity – Sacral Roots

• Even though can have a characteristic appearance, not everything that looks like a chordoma is a chordoma • Surgery for chordomas are high risk, and very invasive surgeries • Surgical strategy should be kept in mind when planning a

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Rectal CA 14 Other 21 Chordoma Mets 23 85

Osteoblastoma 4 ABC 2 Giant Cell 5

Hemangioma 7

Chondrosarcoma 6 48

C1 0 C1 0 C2 4 C2 4 C3 5 C4 4 C3 5 C5 3 C4 4 C6 5 C5 3 C7 2 C6 5 T1 10 C7 2 T2 12 T3 13 10 T4 13 T1 T5 9 T2 12 T6 8 T3 13 T7 12 T4 13 T8 11 T9 10 T5 9 T10 14 T6 8 T11 7 T7 12 T12 10 T8 11 L1 9 T9 10 8 L2 T10 14 L3 16 7 L4 15 T11 L5 19 T12 10

S1 31 9 S2 42 L1 S3 92 L2 8 S4 100 L3 16 S5 105 L4 15 Cx 105 L5 19

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Jean-Paul Wolinsky, MD Professor, Director of Spinal Neurosurgery James Chandler, MD Professor

Terrance Peabody, MD Professor and Chair of Orthopedic Surgery Spinal Reconstruction – Implants Orthopedic Surgery Sam Attar, MD Assistant Professor

Greg Dumanian, MD Professor and Chair of Plastic Surgery

Mohammed Alghoul, MD Assistant Professor • Evolution of Implants Plastic Surgery – Marco Ellis, MD Assistant Professor Hooks/Rods/Cables Jason Ko, MD Assistant Professor – Pedicle Screws – Anterior Plating Systems Colorectal Surgery Amy Halverson, MD Professor – Lateral Mass Instrumentation Mark Eskandari, MD – Professor Cages Heron Rodriguez, MD Associate • Titanium Mesh Vascular Surgery Professor Andrew Hoel, MD Assistant Professor • Expandable Cages Northwestern Chordoma Center – Custom Implants Tad Tomita, MD Assistant Professor • Evolution of Implant Materials Urology – Stainless Steel Roger Stupp, MD Professor Medical Oncology – Titanium Mark Agulnik, Associate Professor – Cobalt-Chromium – PEEK Proton Therapy Vinai Gondi, MD Proton Therapy – Carbon Fiber John Kalapurakal, MD Professor • Thought to implants and Postoperative Radiation Therapy Sean Sachte, MD Assistant Professor treatment strategies Tim Kruser, MD Assistant Professor – Imaging Northwestern Nervous System Tumor Bank – Radiation Portals Pathology Craig Horbinski, MD Associate Professor Borislav A Alexiev,, MD Associate Professor

Rehabilitation

Interventional Neuroradiology Babak Jahromi, MD Professor

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