Surgical Management of Spinal Chondrosarcoma: Retrospective Case Series and Systematic Review of the Literature

BACKGROUND AND OBJECTIVES: Spinal chondrosarcomas are locally aggressive primary malignant tumors that are often resistant to chemotherapy and radiation. Wide surgical resection with negative margins remains the cornerstone of treatment. We present our institutional experience and review the literature regarding outcomes after surgical resection for spinal chondrosarcoma. METHODS: We retrospectively reviewed patients who underwent surgical resection for spinal chondrosarcoma at a tertiary care center. Primary outcomes were progression-free survival and overall survival; secondary outcomes were functional neurological outcomes. Patients were stratified by Enneking Appropriate (EA) vs Enneking Inappropriate (EI) resections. We performed a systematic review and meta-analysis to summarize recurrence and survival estimates. RESULTS: Twenty-nine patients underwent resection. The median age was 43 years (IQR 34-50), and the median follow-up was 5.6 years (IQR 2.4-8.2). Tumors commonly involved the thoracic spine (48%). Gross total resection was achieved in 83% of patients, and 66% had EA resections. Thirty-day complications occurred in 59%. Adjuvant radiation therapy was administered in 9/29 (31%) patients for high-grade histology, positive margins, or residual tumor. Pain improved or resolved in 26/29 (90%) patients. Local recurrence occurred in 7/29 (24%) and distant metastasis in 4/29 (14%) at a median of 3.5 years. Patients who had EA resection had improved progression-free survival compared with those who had EI resection (EI hazard ratio 5.56, CI 1.7-20.8, P = .006) and a trend toward improved overall survival (EI hazard ratio 7.14, 95% CI 0.7-125, P = .091). Our systematic review and meta-analysis demonstrated similar associations between en bloc/EA resections, reduced local recurrence, and improved survival. CONCLUSION: In patients with spinal chondrosarcoma, EA resections are associated with fewer tumor recurrences and improved survival compared with EI resections. Although aggressive surgical resections with curative intent carries risks of perioperative complications and new neurological deficits, most patients achieve favorable discharge disposition and maintain ambulatory independence.