Lumbar Chordoma Presenting as an Epidural Collection with Vertebral Destruction- An Unusual Cause of Lumbar Canal Stenosis

Abstract

Chordomas are locally aggressive neoplastic lesions that arise from physalipherous cell nests that originate from notochordal remnants left behind during early foetal development. Chordomas of the mobile spine (C3-L5) constitute less than 5% of the overall incidence of chordomas in the spine. They generally are osteodestructive leading to vertebral collapse and severe deficits including paraplegia and quadriplegia. Here authors presented a case of 26-year-old female presented with severe bilateral L5 radicular pain, no deficits and intact bladder and bowel control. The pain was progressive and resistant to analgesic medication. On imaging a collection in the lumbar spine emanating from the L5 vertebral body extending into the canal leading to secondary spinal canal stenosis was observed. On surgical exploration a soft friable vascular mass compressing the dural tube and the exiting nerve roots was observed and the mass was analysed and found to be a chordoma. Although, these lesions are seen to compress the vital neural elements of the spine, the presence of a collection in the spinal canal was unusual and resembled tuberculosis which is a much common lesion, or pyogenic osteomyelitis of the vertebral body. Both differentials were proven wrong. Such an approach not only detected and treated the lesion early, but good rehabilitation and adjuvant therapy was initiated enabling excellent overall quality of life to the patient.