Total en bloc spondylectomy of C5 vertebra for chordoma

Study Design. En bloc resection of a chordoma of the C5 vertebra with wide surgical margins. Objective. To present the surgical technique of total spondylectomy for a chordoma of the C5 vertebral body. Summary of Background Data. Malignant bone tumors require wide resection. Wide resection by total en bloc spondylectomy is difficult or not feasible for malignant vertebral tumors of the cervical spine due to the peculiar anatomic complexity of this region, including the vertebral arteries and the neural structures. There are no previous reports of en bloc resection of cervical spine tumors with wide surgical margins. Methods. Using staged posterior and anterior approaches, a total en bloc spondylectomy and spine arthrodesis was performed. En bloc excision of a C5 chordoma was achieved using a threadwire T-saw (Tomita and Kawahara, Kanazawa, Japan) with surgical margins free of tumor. The patient received postoperative adjuvant proton beam radiation therapy. Results. The patient remains disease-free 9 years after the operation. Conclusion. Total en bloc spondylectomy with wide surgical margins is feasible for malignant bone tumors of the cervical spine.