Hybrid therapy and use of carbon-fiber-reinforced polyetheretherketone instrumentation for management of mobile spine chordomas: A case series and review of the literature.

BackgroundMobile spine chordomas demonstrate varied surgical risk profiles compared to their sacral analogs. Often, the limitation to performing an en bloc resection of a mobile spine chordoma is tumor violation of the epidural space. Given these limitations, we propose the utilization of carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation in separation surgery to enhance visualization for stereotactic body radiation therapy (SBRT) planning, allowing an ablative radiosurgical dose to be delivered.MethodsWe present two illustrative cases highlighting the advantages of hybrid therapy (separation surgery and adjuvant SBRT) with CFR-PEEK instrumentation in the management of mobile spine chordoma.ResultsCase 1 is a 62-year-old female with an L4 chordoma who underwent separation surgery and L3-5 posterior instrumented fusion using CFR-PEEK instrumentation. Case 2 is a 68-year-old female with a L3 chordoma who underwent revision separation surgery encompassing completion of L3 partial corpectomy and CFR-PEEK screw exchange of prior L2-4 titanium instrumentation. Both patients received postoperative ablative SBRT. At 18-month postoperative time points, both patients were clinically stable, with no signs of tumor recurrence or progression.ConclusionMobile spine chordomas present a unique challenge in obtaining a margin negative en bloc resection. Separation surgery allows the ability to decrease surgical morbidity and deliver an ablative radiosurgical dose. Furthermore, the incorporation of CFR-PEEK instrumentation allows the utilization of multiparametric magnetic resonance imaging for long-term disease monitoring. Hybrid therapy, a less morbid alternative to standard en bloc spondylectomy, offers a better surgical morbidity profile by combining effectively with SBRT for optimal tumor control.