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Lumbar adjacent segment disease

Introduction Back pain is prevalent in the United States and worldwide. Lumbar arthrodesis techniques are being increasingly used to address congenital, degenerative, and traumatic spinal pathologies. Adjacent segment degeneration continues to be a very common sequela of lumbar arthrodesis occurring in up to 77% of patients and resulting in back pain and progressive neurological deficits. The treatment is surgical and should be tailored to the patient.…

Adjacent segment disease after anterior cervical decompression and fusion

Introduction Anterior cervical decompressions and fusions (ACDFs) are one of the most common spine surgeries worldwide and the gold standard treatment for symptomatic cervical spondylosis. Adjacent segment disease is a very common sequela and occurs in about 26% of all patients within 10 years from surgery requiring reoperation. The best treatment modality is a matter of debate and should be tailored to the patient. In this…

Recurrent herniated disc at the same level in a young patient

Introduction The intervertebral disc allows axial loading that results from an upright posture of the spine. The disc is composed of two components, the outer fibrous annulus fibrosus and the central nucleus pulposus, and originates from the notochord. The nucleus pulposus is composed of proteoglycans and water gels held together by type II collagen and elastin fibers. These acts as a shock absorber that helps distribute…

Lumbar degenerative spondylolisthesis

Introduction Low back pain is prevalent in the United States and the world, and spondylolisthesis is one of the most common causes of back pain with an estimated prevalence of 11.5%. Spondylolisthesis refers to the anterior, posterior, or rotational translation of a vertebra relative to another that occurs after an acquired (traumatic fracture, iatrogenic, etc.) or congenital bony defect in the pars interarticularis or a facet…

Grade 1 spondylolisthesis without instability on flexion/extension and claudication

Introduction Spondylolisthesis was first described by Herbiniaux, who noted the presence of a lumbar vertebrae ventral to the sacrum causing an obstruction to the progression of labor during a routine pelvic exam. The term “spondylolisthesis,” however, was not used until Kilian reported the cause of this condition due to the subluxation of the facet joint. Lumbar spondylolisthesis is described as ventral subluxation of one vertebrae body…

Sarcoma Patient Advocacy : Hope and Help

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Patient advocacy is the endeavor where laypeople advocate for patients, survivors and caregivers inside the healthcare ecosystem. While healthcare is intrinsically about patient care and outcomes, the complexity of the current healthcare ecosystem often creates many situations where the interests of the…

The Chordoma Foundation

Introduction The Chordoma Foundation (“CF”) is a global nonprofit organization whose mission is to improve the lives of those affected by chordoma and lead the search for a cure. CF unites multiple stakeholders—patients, caregivers, doctors, scientists, drug developers, and others—to pursue a future in which everyone affected by chordoma is able to overcome the disease and maintain his or her quality of life. CF was founded…

Prognosis, Survival, and Surveillance

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Chordoma Prognostic Factors Patient age at diagnosis, tumor characteristics including pathological features, molecular markers, and cytogenetics, and treatment rendered including extent of removal, adjuvant radiation, and prior therapy have all been linked with chordoma relapse and patient mortality in a number of…

Chordomas and Chondrosarcomas of the Axial Skeleton: Emerging Therapies and Future Directions

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction: Barriers to Traditional Therapies Chordoma and chondrosarcoma are closely related malignant tumors; in fact, a subtype of chordoma, chondroid chordoma, contains cartilage ( Fig. 39.1 ). The etiology of malignant cartilage tumors has been more thoroughly investigated than that of chordoma.…

Systemic Therapies for Locally Recurrent or Metastatic Disease

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Chordoma Given the rarity of chordoma, prospective data to guide treatment are limited. Historically, definitive treatment and local control of the primary site of disease have been the focus of chordoma treatment, both in the clinical and research realms. Improvement of local…

Recurrent Skull Base Chordomas : Role of Surgery

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction Chordomas are unusual malignant dysontogenic neoplasms with a low incidence (less than 0.03 per 100,0000 person) and unpredictable growth rate. Chordomas are invasive and locally destructive. Their pathological diagnosis can only be confirmed by immunohistochemical stains. Midline origin from rather thin…

Chordomas and Chondrosarcomas in Children

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Incidence Cranial base chondroid tumors are rare in the pediatric population. Chordomas constitute only 3% of all primary bone tumors, of which fewer than 5% (reported range: 2%–15%) occur in children (<21 years age). In adults, chordomas occur predominantly in males, with…

Heavy Ion Radiation for Chordomas and Chondrosarcomas

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction Radiotherapy seeks application of a curative dose to tumor with maximum sparing of healthy normal tissue. Newer photon techniques achieve highly conformal treatment at the cost of increased integral dose to normal tissue with higher risk of secondary malignancy. Particle therapy…

Proton Therapy for Spinal Chordomas and Chondrosarcomas

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. General Comments Chordomas and chondrosarcomas are quite uncommon, with an estimated annual incidence of ∼1320 chondrosarcomas and ∼300 chordomas in the United States. Accordingly, the clinical outcome data for different management strategies are quite modest and data from randomized clinical trials are…

Photon Irradiation for Spinal Chordomas and Chondrosarcomas

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction Chordoma is a rare malignancy arising from remnants of the embryonic notochord at an estimated incidence of <1 per 100,000 and a median age at diagnosis of 59 years. Most chordomas present in the spine, either the mobile spine (53%) or…

Proton Therapy for Skull Base Chordomas and Chondrosarcomas

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction Although they arise from different tissues, chordomas and many chondrosarcomas share similarities in natural history and location such that they can be misdiagnosed for each other; a differential diagnosis is often required to ascertain the pathology of the tumor. Neither tumor…

Stereotactic Radiosurgery for Skull Base Chordomas and Chondrosarcomas

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Background Chordomas are relatively rare tumors, with an overall incidence of 8.4 per 10 million population. They arise from embryonic notochordal remnants along the neuraxis. These remnants usually remain in or close to the midline, entrapped within bone. Therefore, chordomas are typically…

Fractionated Photon Radiation Therapy for Skull Base Chordomas and Chondrosarcomas

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction The fundamental challenge to effectively managing chordomas and chondrosarcomas arising in the base of the skull is the anatomic location of the tumor. The standard treatment is initially surgery, typically followed by postoperative radiation therapy; this combination is advocated because the…

Surgical Treatment of Sacral Chordoma

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction Chordoma is a rare, indolent primary bone malignancy. It comprises 1%–4% of primary bone malignancies. The incidence is 0.08 in 100,000; it has a male predominance (∼2:1) and a peak presentation between 50 and 60 years. Chordoma, in originating from the…

Anatomical Considerations for Resection of Chordomas and Chondrosarcoma of the Sacrum

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. The sacrum is contained within one of the most anatomically complex and surgically inaccessible areas of the human body. It is wedged behind and between both iliac wings and is bound by ligaments to the mobile spine and mid-pelvis. The nearby pelvic…