• Yuanxuan Xia, Pritika Papali, Abdel-Hameed Al-Mistarehi, Landon J Hansen, Tej D Azad, A Karim Ahmed, Christian Meyer, John Gross, Majid Khan, Chetan Bettegowda, Debraj Mukherjee, Timothy Witham, Ali Bydon, Nicholas Theodore, Jean-Paul Wolinsky, Ziya Gokaslan, Larry LoSheng-FuSFDepartment of Neurosurgery, Zucker School of Medicine at Hofstra, Manhasset, New York, USA., Daniel Sciubba, Sang H Lee, Kristin J Redmond, and Daniel Lubelski.
• Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
• Neurosurgery. 2024 Aug 5.

Background And ObjectivesSpinal chordomas are primary bone tumors where surgery remains the primary treatment. However, their low incidence, lack of evidence, and late disease presentation make them challenging to manage. Here, we report the postoperative outcomes of a large cohort of patients after surgical resection, investigate predictors for overall survival (OS) and local recurrence-free survival (LRFS) times, and trend functional outcomes over multiple time periods.MethodsRetrospective review of all patients followed for spinal chordoma at a quaternary spinal oncology center from 2003 to 2023 was included. Data were collected regarding demographics, preoperative and perioperative management, and follow-up since initial definitive surgery. Primary outcomes were OS and LRFS, whereas secondary outcomes were functional deficits.ResultsOne hundred one patients had an average follow-up of 6.0 ± 4.2 years. At the time of census, 25/101 (24.8%) had experienced a recurrence and 10/101 (9.9%) had died. After surgery, patients experienced a significant decrease in pain over time, but rates of sensory deficits, weakness, and bowel/bladder dysfunction remained static. Tumors ≥100 cm3 (hazard ratio (HR) = 5.89, 95% CI 1.72-20.18, P = .005) and mobile spine chordomas (HR = 7.73, 95% CI 2.09-28.59, P = .002) are related to worse LRFS, whereas having neoadjuvant radiotherapy is associated with improved LRFS (HR = 0.09, 95% CI 0.01-0.88, P = .038). On the other hand, being age ≥65 years was associated with decreased OS (HR = 16.70, 95% CI 1.54-181.28, P = .021).ConclusionSurgeons must often weigh the pros and cons of en bloc resection and sacrificing important but affected native tissues. Our findings can provide a benchmark for counseling patients with spinal chordoma. Tumors ≥100 cm3 appear to have a 5.89-times higher risk of recurrence, mobile spine chordomas have a 7.73 times higher risk, and neoadjuvant radiotherapy confers an 11.1 times lower risk for local recurrence. Patients age ≥65 years at surgery have a 16.70 times higher risk of mortality than those <65 years.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.

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