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En-bloc resection of a chordoma in L3 by a combined open posterior and less invasive retroperitoneal approach: technical description and case report



To fulfill oncological criteria, extensive open anterior and posterior approaches are usually performed in the lumbar spine to obtain an appropriate en-bloc spondylectomy. It is commonly accepted that the price of a tumor-free margin includes such extensive incisions and soft-tissue damage, with consequent relevant blood loss and possible postoperative complications as delayed wound healing. In this article, a case of chordoma in L3 is presented, submitted to an oncologically appropriate en-bloc resection performed by an open posterior approach combined with a mini-retroperitoneal approach. The successful oncologic procedure was combined with a short and uneventful postoperative course.

Materials and methods

The authors present the surgical technique and the possible challenges of minimally invasive anterior oncologic surgery as a contribution to a limited literature.


Up to date, palliative care of single metastases has been the main setting in which anterior, minimally invasive surgery has been performed in the lumbar spine. The authors explained how, in selected cases, this approach can be performed in combination with an open posterior access for an oncologically appropriate treatment of a primary malignant tumor.


Anterior, minimally invasive surgery can have a role in selected patients with primary malignant tumors of the lumbar spine. The surgical team should have extensive training both in oncologic and minimally invasive surgery.

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  1. Gokaslan ZL, Zadnik PL, Sciubba DM et al (2016) Mobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database. J Neurosurg Spine 24:644–651.

    Article  PubMed  Google Scholar 

  2. Boriani S, Bandiera S, Biagini R et al (2006) Chordoma of the mobile spine: fifty years of experience. Spine 31:493–503.

    Article  PubMed  Google Scholar 

  3. Smolders D, Wang X, Drevelengas A et al (2003) Value of MRI in the diagnosis of non-clival, non-sacral chordoma. Skeletal Radiol 32:343–350.

    CAS  Article  PubMed  Google Scholar 

  4. Boriani S (2018) En bloc resection in the spine: a procedure of surgical oncology. J Spine Surg 4:668–676.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sciubba DM, de Ramos LGR, Goodwin CR et al (2016) Total en bloc spondylectomy for locally aggressive and primary malignant tumors of the lumbar spine. Eur Spine J 25:4080–4087.

    Article  PubMed  Google Scholar 

  6. Biagini R, Casadei R, Boriani S et al (2003) En bloc vertebrectomy and dural resection for chordoma: a case report. Spine 28:E368–E372.

    Article  PubMed  Google Scholar 

  7. Rhines LD, Fourney DR, Siadati A et al (2005) En bloc resection of multilevel cervical chordoma with C-2 involvement. Case report and description of operative technique. J Neurosurg Spine 2:199–205.

    Article  PubMed  Google Scholar 

  8. Gösling T, Pichlmaier MA, Länger F et al (2013) Two-stage multilevel en bloc spondylectomy with resection and replacement of the aorta. Eur Spine J 22(Suppl 3):S363–S368.

    Article  PubMed  Google Scholar 

  9. Murakami H, Tomita K, Kawahara N et al (2006) Complete segmental resection of the spine, including the spinal cord, for telangiectatic osteosarcoma: a report of 2 cases. Spine 31:E117–E122.

    Article  PubMed  Google Scholar 

  10. Boriani S, Weinstein JN, Biagini R (1997) Primary bone tumors of the spine. Terminology and surgical staging. Spine 22:1036–1044.

    CAS  Article  PubMed  Google Scholar 

  11. Roy-Camille R (1990) Rachis Dorsal et Lombaire. Masson, Paris

    Google Scholar 

  12. Boriani S, Bandiera S, Donthineni R et al (2010) Morbidity of en bloc resections in the spine. Eur Spine J 19:231–241.

    Article  PubMed  Google Scholar 

  13. Berjano P, Damilano M, Lamartina C (2012) Sagittal alignment correction and reconstruction of lumbar post-traumatic kyphosis via MIS lateral approach. Eur Spine J 21:2718–2720.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fang T, Dong J, Zhou X et al (2012) Comparison of mini-open anterior corpectomy and posterior total en bloc spondylectomy for solitary metastases of the thoracolumbar spine. J Neurosurg Spine 17:271–279.

    Article  PubMed  Google Scholar 

  15. Rose PS, Clarke MJ, Dekutoski MB (2011) Minimally invasive treatment of spinal metastases: techniques. Int J Surg Oncol 2011:494381.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Molina CA, Gokaslan ZL, Sciubba DM (2011) A systematic review of the current role of minimally invasive spine surgery in the management of metastatic spine disease. Int J Surg Oncol 2011:598148.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Goomany A, Timothy J, Robson C et al (2016) En bloc resection of a thoracic chordoma is possible using minimally invasive anterior access: an 8-year follow-up. J Neurosci Rural Pract 7:138–140.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Pennicooke B, Laufer I, Sahgal A et al (2016) Safety and local control of radiation therapy for chordoma of the spine and sacrum: a systematic review. Spine 41(Suppl 20):S186–S192.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fisher CG (2010) Timing of surgery and radiotherapy in the management of metastatic spine disease: a systematic review. Int J Oncol.

    Article  PubMed  Google Scholar 

  20. Mesfin A, Sciubba DM, Dea N et al (2016) Changing the adverse event profile in metastatic spine surgery: an evidence-based approach to target wound complications and instrumentation failure. Spine 41(Suppl 20):S262–S270.

    Article  PubMed  Google Scholar 

  21. Boriani S, Tedesco G, Ming L et al (2018) Carbon-fiber-reinforced PEEK fixation system in the treatment of spine tumors: a preliminary report. Eur Spine J 27:874–881.

    Article  PubMed  Google Scholar 

  22. Mastella E, Molinelli S, Magro G et al (2017) Dosimetric characterization of carbon fiber stabilization devices for post-operative particle therapy. Phys Med 44:18–25.

    CAS  Article  PubMed  Google Scholar 

  23. Xin-ye N, Xiao-bin T, Chang-ran G et al (2012) The prospect of carbon fiber implants in radiotherapy. J Appl Clin Med Phys 13:3821.

    Article  PubMed  Google Scholar 

  24. Berjano P, Balsano M, Buric J et al (2012) Direct lateral access lumbar and thoracolumbar fusion: preliminary results. Eur Spine J 21(Suppl 1):S37-42.

    Article  PubMed  Google Scholar 

  25. Formica M, Berjano P, Cavagnaro L et al (2014) Extreme lateral approach to the spine in degenerative and post traumatic lumbar diseases: selection process, results and complications. Eur Spine J 23(Suppl 6):684–692.

    Article  PubMed  Google Scholar 

  26. Berjano P, Garbossa D, Damilano M et al (2014) Transthoracic lateral retropleural minimally invasive microdiscectomy for T9–T10 disc herniation. Eur Spine J 23:1376–1378.

    Article  PubMed  Google Scholar 

  27. Berjano P, Damilano M, Ismael M et al (2015) Anterior column realignment (ACR) technique for correction of sagittal imbalance. Eur Spine J 24(Suppl 3):451–453.

    Article  PubMed  Google Scholar 

  28. Berjano P, Lamartina C (2013) Far lateral approaches (XLIF) in adult scoliosis. Eur Spine J 22(Suppl 2):S242–S253.

    Article  PubMed  Google Scholar 

  29. Mi C, Lu H, Liu H (2005) Surgical excision of sacral tumors assisted by occluding the abdominal aorta with a balloon dilation catheter: a report of 3 cases. Spine 30:E614–E616.

    Article  PubMed  Google Scholar 

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Correspondence to Alice Baroncini.

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Conflict of interest

Pedro Berjano: grants and personal fees from Nuvasive, personal fees from Depuy Sinthes, personal fees from Medacta, personal fees from Zimmer, personal fees from K2M, personal fees from Medtronic, and grants from Stoeckli Medical, from null, outside the submitted work; Alice Baroncini: none; Riccardo Cecchinato: personal fees from Nuvasive and personal fees from Medacta, outside the submitted work; Francesco Langella: none; Stefano Boriani: personal fees from Nuvasive and personal fees from Stryker, outside the submitted work.

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Berjano, P., Baroncini, A., Cecchinato, R. et al. En-bloc resection of a chordoma in L3 by a combined open posterior and less invasive retroperitoneal approach: technical description and case report. Arch Orthop Trauma Surg (2021).

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  • Chordoma
  • Minimally invasive surgery
  • Trans-psoas approach
  • Lumbar spine tumor
  • Malignant spine tumor