Recurrent L3 Chordoma Presented as Intradural Extramedullary Mass With Distant Metastasis: A Case Report

Here, we report a rare case of L3 chordoma progressed to an intradural extramedullary (IDEM) mass and distant metastasis to the fascia lata. A 64-year old female patient presented to a local university hospital due to back pain and received excisional biopsy for a L3 destructive bony lesion. Local radiation therapy was initially administered, assuming a malignancy of unknown origin, but she developed cerebrospinal fluid leakage during adjuvant radiation therapy, which was managed by wound revision and lumbar drainage. As the destructive lesion progressed, she visited our hospital for a second opinion 3 months after the biopsy. After review of outside pathology, we diagnosed the lesion to be a chordoma, and performed a L3 corpectomy with cage and plate fixation. One and a half years later, positron emission tomography and computed tomography (PET-CT) revealed a right tensor fascia lata hypermetabolic lesion. Excisional biopsy confirmed a distant metastasis of the chordoma. One year later, she complained of L2 radiating pain. PET-CT and CT myelogram revealed an IDEM lesion. Surgical excision confirmed the transdural invasion of the chordoma. To our knowledge, this is the first report of an iatrogenic IDEM invasion and distant metastasis to the tensor of the fascia lata by a L3 chordoma.

The Efficacy of Percutaneous Long-Segmental Posterior Fixation of Unstable Thoracolumbar Fracture with Partial Neurologic Deficit

STUDY DESIGN: Retrospective analysis. PURPOSE: The aim of this study was to evaluate the clinical and radiological outcomes of patients with unstable thoracolumbar fracture (UTLF) who were treated by percutaneous long-segmental posterior fixation (PLSPF) by two vertebrae cranial to the fracture with two vertebrae caudal. OVERVIEW OF LITERATURE: To the best of our knowledge, PLSPF for stabilization of UTLF has not been reported. METHODS: The study involved retrospective analysis and investigation from the results of 27 patients who had undergone PLSPF for stabilization of a UTLF with partial neurologic deficit, over a follow-up period of two years. Kyphotic angle (KA), anterior vertebral height percentage (AVHP) and cross-sectional ratio of the displaced fragment within the spinal canal were evaluated with simple radiographs and axial computed tomography scans preoperatively and two years postoperatively. The clinical outcome for pain was assessed by a visual analogue scale (VAS) and Denis' scale, and the degree of neurologic deficit was measured by modified Frankel classification. RESULTS: Five patients had minor complications. The KA, AVHP, and cross-sectional ratio of the displaced fragment improved significantly after surgery (p<0.001, p<0.001, p<0.003, respectively). Neurologic recovery of one or more for the Frankel grade was seen in 19 patients with an average improvement of 1.7. The VAS and Denis' score improved significantly at a two year follow-up (p=0.02, p=0.012, respectively). CONCLUSIONS: The technique of PLSPF is useful for the treatment of UTLF with partial neurologic deficit, and produces decreased morbidity and fewer complications.