Clinical Neuroscience

[Surgical treament of sacro-coccygeal chordoma]

VARGA Péter Pál1,2,3

FEBRUARY 20, 2003

Clinical Neuroscience - 2003;56(01-02)

[Chordoma is an uncommon malignant tumor with unusual characteristics developing in the remnants of the notochord and usually manifesting itself in patients in their forties and fifties. It is usually located in the body's symmetrical axis or attached to it. The pathological structure is rather characteristic to benign tumors. Although not painful, it is a mercilessly aggressive local tumor, in some cases resulting metastatic progression and might alter its histological picture in longlived patients. It is found most prevalently (about 60 percent) in the sacrococcygeal region and at the clivus and manifesting itself spinally (over the sacrum) most likely in the lumbar region. Between 1992 and 2002, the authors have treated surgically 37 patients with sacrococcygeal chordoma. They applied wide resection following which only seven patients required re-operation. They show detailed data regarding this patient group and discuss the technical aspects of the wide tumorresection.]


  1. Semmelweis Egyetem, Ortopédiai Klinika, Budapest
  2. Magyar Honvédség, Központi Honvédkórház, Gerincsebészeti Osztály
  3. Gerincgyógyászati Nemzeti Központ, Budapest



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[Case report - Authors report a case of thyroid gland carcinoma. The tumor had metastases into the CV-VI-VII vertebras. Through an anterior approach, they removed the malignant tumor together with the bodies of the affected cervical vertebras and a two stage combined (anterior and posterior) cervical instrumentation was performed. The anterior fusion was carried out with iliac crest bone grafting and plate fixation. After four years the patient is alive and well, without symptoms of tumor recurrence or neurologic deficiency. The ventral fusion is stable. Conclusions - Authors present a case of a successful operation of thyroid gland malignant tumor having metastatases in the CV-VI-VII vertebras. Tumor resection, fusion and instrumentation is suggested to be carried out in one stage. The anterior and posterior instrumentation is essential. Radical removal of the tumor is mandatory even with complex instrumentation and oncotherapy procedures.]

Clinical Neuroscience

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[With the aim to compare results to those found in the literature, authors present a retrospective overview of the spinal stabilisations carried out in the Neurosurgical Department at the St. John’s Hospital, Budapest, Hungary between 1989 and 2002. This 37 bed department provides neurosurgical services to the Buda region with its one million inhabitants. Out of 156 000 injuries in total in the past 13 years, the department has dealt with 9360 neurotraumatologic cases, 560 of them suffering from spinal injuries. In parallel, non-traumatic cases were also treated for tumour, infections, degenerative diseases and for the instability of the spine. The 224 stabilised cases were classified into three groups: cervical, thoracic, lumbar. The authors enumerate the type of operation in each level and they present the number of cases belonging to each type. Septic complications occured in 2.5% of cases. Screw breaking or slackening of the implanted devices was observed in 2% of the cases. The types of spinal operations applied provide satisfactory method for controlling the problems caused by the instability the spinal trauma, degenerative and tumourous cases. These results do not diverge from those found in the literature.]

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