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

Background: Mobile 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.

Methods: We 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.

Results: Case 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.

Conclusion: Mobile 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.