Multilevel En-Bloc Excision of Thoracic Spine Primary Chondrosarcoma Through an All-Posterior Approach: A Report of Two Cases

Chondrosarcomas are malignant, cartilage-forming neoplasms. As these tumours are resistant to chemotherapy and radiotherapy, en-bloc excision of the tumour with wide margins is the only option that provides maximum disease-free survival and possible cure. We present two cases of primary chondrosarcoma of the thoracic spine treated by multilevel en-bloc excision through an all-posterior approach. Case 1 describes a 48-year-old female who presented with mid-back pain for six months. MRI revealed an expansile lesion between T9 and T11; a biopsy confirmed this to be chondrosarcoma. Following a posterior-only approach, the entire tumour mass with the overlying pleura, part of the T9-T11 vertebral body and the posterior elements, as well as the posteromedial part of the ninth, tenth, and eleventh ribs, were removed en bloc. Case 2 describes a 29-year-old male who presented with mid-back pain for five months. MRI revealed a lesion at T10, which was later confirmed on histopathological examination to be chondrosarcoma, affecting T9-T11. Using a posterior-only approach, the entire tumour mass, with part of T8-T11 was delivered en bloc. Both patients made an uneventful recovery, and there were no signs of disease at 24 months post-operatively. Despite being technically demanding, multilevel en-bloc tumour resection of the spine remains the mainstay in certain primary tumours, as it is potentially curative. Although the overall complication percentage following multilevel en-bloc resections was high, the local recurrence rate was significantly low. While most published articles recommend a posterior-only approach for limited disease, the cases in this report suggest that a posterior-only approach could also be viable for select cases of multilevel chondrosarcoma.