Surgical management of chordomas and chondrosarcomas of the lumbar spine

Chordomas and chondrosarcomas are rare primary malignant spine tumors. In spite of recent advancements in chemotherapy, targeted therapy, and radiation therapy, surgery remains the gold standard for treatment of these lesions. Specifically, en bloc resection with wide tumor-free margins has better outcomes in terms of duration of disease-free and overall survival than does intralesional resection. Nonetheless, en bloc resections in the spine are technically demanding and highly morbid procedures, particularly in the lumbar spine because of the proximity of the lumbar plexus, great vessels, iliopsoas muscle, bowel, and others. This chapter reviews the operative management of lumbar chordomas and chondrosarcomas, emphasizing the surgical technique to achieve an en bloc resection via spondylectomy.