Surgical Management of Spinal Chordomas: A Narrative Review

Background: Chordomas are rare malignant tumors derived from notochordal remnants, accounting for 1–4% of skeletal malignancies. These slow-growing tumors most commonly affect the sacrum, skull base, and spine, posing significant challenges due to their anatomical location near critical neural structures. Despite their low metastatic potential, chordomas have a high local recurrence rate, necessitating aggressive surgical intervention. Methods: A narrative review of the literature was conducted, analyzing studies on the surgical management and adjuvant radiotherapy of spinal chordomas. Electronic databases, including MEDLINE, Scopus, ProQuest, and Google Scholar, were searched using relevant keywords. The retrieved studies were reviewed to assess surgical approaches, complications, outcomes, and the role of radiation therapy in treatment. Results: En-bloc resection with negative margins remains the primary treatment approach for spinal chordomas, though achieving complete excision is challenging due to anatomical constraints. Advances in radiotherapy, including proton beam and carbon ion therapy, have shown promise as adjunct treatments, especially when gross total resection is not possible. However, the benefit of adjuvant radiation remains debated. Postoperative complications, such as infections, neurological deficits, and mechanical instability, highlight the need for a multidisciplinary approach in patient management. Conclusion: The management of spinal chordomas requires an individualized treatment approach, balancing surgical feasibility, functional preservation, and disease control. While en-bloc resection remains the gold standard, newer radiotherapy techniques may improve outcomes in select cases. A multidisciplinary team is essential to optimize prognosis and quality of life for affected patients.