A total en bloc spondylectomy and reconstruction of vertebra thoracal IV-VI in primary large chondrosarcoma: A rare surgical case report

Chondrosarcomas are rare malignant cartilaginous neoplasms, account for the second most common primary bone tumor. Several surgical approaches for achieving en bloc resection have been mentioned in previous studies. This study aimed to present a rare case of chondrosarcoma involving T4-T6 vertebrae that underwent total spondylectomy. A 36-year-old male was presented with signs and symptoms of thoracal foraminal stenosis due to mass effect of primary chondrosarcoma arising from the 5th thoracal vertebrae. The plain radiograph and MRI showed the characteristic features of chondrosarcoma. Biopsy result was a grade I chondrosarcoma. The patient underwent total spondylectomy of T4-T6 vertebrae, along with posterior stabilization, tubular cage insertion, thoracotomy, and bilateral chest tube insertion. Most complaints of spinal chondrosarcomas are localized back pain, swelling, and neurological deficits. The radiological features vary significantly, starts with lysis, to a moth-eaten destruction and interrupted periosteal reaction. Biopsy may classify the disease into conventional and variant types. The former one can further classified as primary and secondary tumor, both are graded as relation to prognosis and metastases. The primary treatment is surgical excision, while radiotherapy and chemotherapy are resistant in many cases. Recurrence commonly appears within 3–5 years postoperatively. As the primary modality for chondrosarcoma, surgery should aim at preserving or even improving functionality, relieving pain, and controlling local tumor recurrence, promising a prolonged survival. Besides the tumor grade, a successful operation, in terms of complete tumor excision with disease-free margins is a major independent prognostic predictor of the disease, affecting critically both local tumor control and patient survival. Spondylectomy enables wide or marginal resection of malignant lesions of the spine in most cases with acceptable morbidity. However, it induces a significant surgical challenge. The proximity of neurovascular and visceral structures combined with complex spinal anatomy makes the goal of wide margins difficult. • This case report details a rare occurrence of chondrosarcoma involving the T4-T6 vertebrae, a significant challenge due to the complex anatomy and proximity to vital structures. • The patient underwent a total en bloc spondylectomy, which is considered the gold standard for achieving wide or marginal resection of malignant spinal tumors. • The surgery involved a multidisciplinary team approach including spine, orthopaedics oncology, and thoracic and cardiovascular surgery divisions. • Reconstruction was performed using an intervertebral titanium tubular ring cage and posterior stabilization with titanium rods. • Postoperative complications included ventilator-associated pneumonia and supraventricular tachycardia, managed in the intensive care unit. • The report underscores the importance of achieving disease-free margins in the surgical treatment of spinal chondrosarcomas to improve patient survival and reduce recurrence rates.