Cervical spinal chondrosarcoma: A surgical technique and an illustrative case report of stepwise staged stabilization for safe resection and reconstruction with 2-year follow-up

Abstract

Cervical spinal chondrosarcoma is a rare malignant tumor, and its management is challenging due to the need for adequate oncological resection while preserving spinal stability and neurological function. A 29-year-old male presented with a 2-month history of neck pain and left upper limb radicular symptoms. Imaging revealed an anterior C7 lesion. An excisional biopsy through a left retropharyngeal approach confirmed Grade II conventional chondrosarcoma. Pre-operative computed tomography angiography confirmed mild anterolateral displacement of the left vertebral artery without dominant-side compromise, guiding the surgical plan. A stepwise staged posterior–anterior–posterior (P-A-P) approach was performed. Initial posterior cervicodorsal fixation (C6 lateral mass and T1 transpedicular screws) provided early stabilization, followed by anterior corpectomy with tumor excision and reconstruction using a polyetheretherketone cage. Final posterior tightening ensured optimal alignment and construct rigidity. Total operative time was 3 h 40 min with an estimated blood loss of 900 mL. Intraoperative neuromonitoring was employed throughout all stages. Gross total resection was achieved without neurological deterioration. Post-operative numerical rating scale pain score improved from 6/10 preoperatively to 1/10 at 6 months. Frankel’s grade remained E throughout. Follow-up up to 2 years demonstrated maintained alignment, stable instrumentation, and no tumor recurrence. A staged P-A-P strategy enables safe tumor resection on a stabilized spine, optimizing both oncological control and biomechanical stability in complex cervical spine tumors.