From Neurosurg Focus. 2006;20(2):E2. Posted 03/28/2006
Daniel R. Fassett, M.D., M.B.A.; Randy Clark, M.S.; Douglas L. Brockmeyer, M.D.; Meic H. Schmidt, M.D.
Abstract Postoperative sagittal-plane cervical spine deformities are a concern when laminectomy is performed for tumor resection in the spinal cord. These deformities appear to occur more commonly after resection of intramedullary spinal cord lesions, compared with laminectomy for stenosis caused by degenerative spinal conditions. Postlaminectomy deformities are most common in pediatric patients with an immature skeletal system, but are also more common in young adults (<25 years of age) in comparison with older adults. The extent of laminectomy and facetectomy, number of laminae removed, location of laminectomy, preoperative loss of lordosis, and postoperative radiation therapy in the spine have all been reported to influence the risk of postlaminectomy spinal deformities. When these occur, patients should be monitored closely with serial imaging studies, because a significant percentage will have progressive deformities. These can range from focal kyphosis to more complicated swan-neck deformities. General indications for surgical intervention include progressive deformity, axial pain in the area, and neurological symptoms attributable to the deformity. Surgical options include anterior, posterior, and combined anterior-posterior procedures. The authors have reviewed the literature on postlaminectomy kyphosis as it relates to resection of cervical spinal cord tumors, and they summarize some general factors to consider when treating these patients.

Isolated posterior and combined anterior and posterior element involvement LCH in children Abstract Paper No: 418 Friday, March 24, 2006 12:06 PM - 12:12 PM Location: McCormick Place S501 Harish Sadanand Hosalkar, MD Philadelphia PA (n) Lubica Jencikova-celerin, MD,PhD London ON Canada (n) John P Dormans, MD Philadelphia PA (n) Moderator(s): Richard E Bowen, MD Los Angeles CA Lori A Karol, MD Dallas TX Pediatrics This is the single largest series presenting isolated posterior and combined anterior and posterior vertebral element . Approximately 7% to 10% of all patients (adult and children) with skeletal LCH have involvement of the spine.

Brief notes and links to images for ARRS members

Chordoma is a relatively rare malignant midline tumor arising in the axial skeleton, primarily at its cranial and caudal ends, that is derived from persistent embryonic notochordal cell rests.

4 synonyms or equivalents were found. Chordoma aka/or Notochordoma aka/or Chordocarcinoma aka/or Chordoepithelioma
Chordoma: Definition(s) via UMLS - "A malignant bone tumor arising from the remnants of the fetal notochord. Although it can occur at all ages, it is more frequently seen in middle-aged adults. Most frequent sites of involvement are: sacrococcygeal area, spheno-occipital area, and the cervico-thoraco-lumbar spine. Microscopically, chordomas are composed of cells that form cords and lobules, separated by mucoid intercellular tissue. Some of the cells are large (physaliphorous) and have vacuolated cytoplasm and prominent vesicular nuclei. Other tumor cells are small with small nuclei, without visible nucleoli. Chordomas tend to recur and may metastasize. The most common sites of metastasis are skin and bone."

Chordomas are rare, clinically malignant tumors derived from notochordal remnants. They occur along the length of the spinal axis, predominantly in the sphenooccipital, vertebral, and sacrococcygeal regions. They are characterized by slow growth, local destruction of bone, extension into adjacent soft tissues, and, rarely, distant metastatic spread.

Chordoma Pre-test and tutorial Frank J. Frassica, MD Professor of Orthopaedics & Oncology Johns Hopkins University Department of Orthopaedic Surgery Baltimore, Maryland Franklin H. Sim, MD Chief, Section of Orthopedic Oncology Mayo Clinic Rochester, Minnesota Section of Orthopedics Hyperguide

Contents - Introduction Differentials Radiograph CT Scan MRI Intervention Multimedia References
Chordomas are tumors originating from embryonic remnants of the primitive notochord. Because chordomas lie in bone, they are usually extradural and induce bone destruction.

Brief Notes - Clinical, Xrays, Pathology, Treatment, Prognosis

Discussion: - rare, slow growing tumor arising from remnants of the notochord in axial skeleton of middle aged adults; - most occur in midline at base of skull and in the sacrococcygeal area (it is the most common primary bone tumor of the sacrum); - classically a slow growing lytic, anterior scaral (50%), or cervical lesion in 35%; - these tumors may present w/ intra-abdominal complaints & presacral mass

six cases of clival chordoma. MRI is the best technique, but CT shows bone destruction. Signs include posterior extension, lobulated, "honeycomb" enhancement, "swollen bone", bone erosion.

Radiology case 331-3141

hemangioma of vertebrae

Journal of Orthopaedic Surgery: 2005 13(3) 232 Review of Hong Kong experience with 12 patients. Conclusion: Surgical stabilization in selected patients provided pain relief and preserved ambulatory status before the deterioration of overall function. (full text)

Article by Huff 2007
Contents - Introduction; Clinical; Differentials; Workup; Treatment; Medication; Follow-up; Miscellaneous; Multimedia; References
Synonyms and related keywords: neoplastic disease, spinal cord compression, primary spinal cord tumors, metastatic lesions, spinal cord dysfunction, spinal cord metastasis, epidural spinal cord compression, partial cord compression, Brown-Séquard syndrome, hemangiomas, scoliosis, torticollis, vertebral metastasis, leptomeningeal metastasis, spinal cord neoplasm
Neoplastic disease that involves the spine with spinal cord compression is an emergency and may be devastating if it goes unrecognized. Primary spinal cord tumors arise from the different elements of the CNS, including neurons, supporting glial cells, and meninges. Anatomically, neoplasms of the spinal cord may be classified according to the compartment of origin, either intramedullary (inside the cord) or extramedullary (outside the cord). Additionally, cancers that metastasize to the vertebrae or surrounding tissues may cause spinal cord compression. Although metastatic lesions are not primary neoplasms arising from neural elements of the spinal cord, they are featured in this discussion because metastases cause 85% of the cases of neoplastic spinal cord compression, and the clinical presentation tends to be indistinguishable from that of primary cancers of the spinal cord.