{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T15:26:25Z","timestamp":1793978785283,"version":"4.8.0"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,24]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Surgery for mobile spine chordomas poses a challenge as en bloc resection often requires nerve root resection. Decision-making is challenging for patients because of this inherent high risk of postoperative deficits, and data demonstrating long-term postoperative functional outcomes are lacking. Here, the authors aimed to show the postoperative functional morbidity of a large series of patients with mobile spine chordomas and detail what was achieved intraoperatively and what nerve root(s) were deemed appropriate for sacrifice in each case.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted of all patients who underwent follow-up for mobile spine chordomas at a quaternary spinal oncology center from 2008 to 2023. Data including intraoperative nerve sacrifices, adjuvant treatments, and functional outcomes at last follow-up were collected. Primary outcomes were neck\/back pain and all-cause motor weakness and sensory deficits at last follow-up, while secondary outcomes were overall survival and local recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Thirty-five patients were included in this cohort with a median follow-up of 5.4 (IQR 4.9\u20139.0) years. Resections were Enneking appropriate (EA) in 23 (65.7%) of the 35 patients, with 13 cases involving nerve root sacrifice. Three of the 12 Enneking inappropriate (EI) cases also had nerve root sacrifice. The proportion of patients with long-term postoperative weakness was similar between patients receiving EA and those receiving EI resection (47.8% vs 41.7%, p &gt; 0.99) as were the rates of nerve root sacrifice (56.5% vs 25.0%, p = 0.152). Notably, 36.8% of patients with no nerve root sacrifice developed unplanned long-term weakness, which highlights how causes of long-term weakness are multifactorial. Nerve root sacrifice was more common in the thoracic spine than cervical or lumbar spine, and lesions in areas of the subaxial cervical and lumbar spines with functional nerve roots did receive surgeries with fewer nerve root sacrifices. At the time of census, 7 (20.0%) patients had died and 14 (40.0%) experienced recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Surgeons must consider the costs and benefits of sacrificing nerve roots to achieve en bloc resection for mobile spine chordomas. Here, the authors catalog a series of mobile spine chordoma resections to help illustrate what is considered acceptable functional morbidity to achieve en bloc results at a large quaternary referral center. They demonstrate that EA surgery is not associated with higher rates of motor weakness and has rates of nerve root sacrifice that are similar to those of to EI surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.2.spine251166","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:01:39Z","timestamp":1784678499000},"page":"622-631","source":"Crossref","is-referenced-by-count":0,"title":["Detailing long-term functional morbidity after resecting mobile spine chordomas across 35 patients"],"prefix":"10.3171","volume":"45","author":[{"given":"Yuanxuan","family":"Xia","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pritika","family":"Papali","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdel-Hameed","family":"Al-Mistarehi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Meyer","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Gross","sequence":"additional","affiliation":[{"name":"Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majid","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chetan","family":"Bettegowda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Witham","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Theodore","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Paul","family":"Wolinsky","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Northwestern University, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziya L.","family":"Gokaslan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Fu Larry","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zucker School of Medicine at Hofstra, Manhasset, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Sciubba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zucker School of Medicine at Hofstra, Manhasset, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salih","family":"Colakoglu","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, The Johns Hopkins Hospital, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang H.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Johns Hopkins Hospital, Baltimore; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin J.","family":"Redmond","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lubelski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"493","article-title":"Chordoma of the mobile spine: fifty years of experience","volume":"31","author":"Boriani S","year":"2006","unstructured":"Boriani S, Bandiera S, Biagini R,  Chordoma of the mobile spine: fifty years of experience. Spine (Phila Pa 1976). 2006;31(4):493\u2013503. doi:10.1097\/01.brs.0000200038.30869.27"},{"issue":"4","key":"b2","series-title":"J Neurosurg Spine","first-page":"644","article-title":"Mobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database","volume":"24","author":"Gokaslan ZL","year":"2016","unstructured":"Gokaslan ZL, Zadnik PL, Sciubba DM,  Mobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database. J Neurosurg Spine. 2016;24(4):644\u2013651. doi:10.3171\/2015.7.SPINE15201"},{"issue":"5","key":"b3","series-title":"J Surg Oncol","first-page":"1284","article-title":"Surgical treatment of primary mobile spine chordoma","volume":"123","author":"Kolz JM","year":"2021","unstructured":"Kolz JM, Wellings EP, Houdek MT, Clarke MJ, Yaszemski MJ, Rose PS. Surgical treatment of primary mobile spine chordoma. J Surg Oncol. 2021;123(5):1284\u20131291. doi:10.1002\/jso.26423"},{"issue":"1","key":"b4","series-title":"Cancer Causes Control","first-page":"1","article-title":"Chordoma: incidence and survival patterns in the United States, 1973\u20131995","volume":"12","author":"McMaster ML","year":"2001","unstructured":"McMaster ML, Goldstein AM, Bromley CM, Ishibe N, Parry DM. Chordoma: incidence and survival patterns in the United States, 1973\u20131995. Cancer Causes Control. 2001;12(1):1\u201311. doi:10.1023\/a:1008947301735"},{"issue":"5","key":"b5","series-title":"Neurosurgery","first-page":"812","article-title":"Prognostic factors in patients with spinal chordoma: an integrative analysis of 682 patients","volume":"81","author":"Zhou J","year":"2017","unstructured":"Zhou J, Sun J, Bai HX,  Prognostic factors in patients with spinal chordoma: an integrative analysis of 682 patients. Neurosurgery. 2017;81(5):812\u2013823. doi:10.1093\/neuros\/nyx081"},{"issue":"4","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"384","article-title":"An assessment of the reliability of the Enneking and Weinstein-Boriani-Biagini classifications for staging of primary spinal tumors by the Spine Oncology Study Group","volume":"34","author":"Chan P","year":"2009","unstructured":"Chan P, Boriani S, Fourney DR,  An assessment of the reliability of the Enneking and Weinstein-Boriani-Biagini classifications for staging of primary spinal tumors by the Spine Oncology Study Group. Spine (Phila Pa 1976). 2009;34(4):384\u2013391. doi:10.1097\/BRS.0b013e3181971283"},{"issue":"5","key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"420","article-title":"Infections in surgery of primary tumors of the sacrum","volume":"37","author":"Ruggieri P","year":"2012","unstructured":"Ruggieri P, Angelini A, Pala E, Mercuri M. Infections in surgery of primary tumors of the sacrum. Spine (Phila Pa 1976). 2012;37(5):420\u2013428. doi:10.1097\/BRS.0b013e3182213a44"},{"issue":"10","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"830","article-title":"Surgical management of primary bone tumors of the spine: validation of an approach to enhance cure and reduce local recurrence","volume":"36","author":"Fisher CG","year":"2011","unstructured":"Fisher CG, Saravanja DD, Dvorak MF,  Surgical management of primary bone tumors of the spine: validation of an approach to enhance cure and reduce local recurrence. Spine (Phila Pa 1976). 2011;36(10):830\u2013836. doi:10.1097\/BRS.0b013e3181e502e5"},{"issue":"1","key":"b9","series-title":"J Neurosurg Spine","first-page":"79","article-title":"Long-term outcomes of high-dose single-fraction radiosurgery for chordomas of the spine and sacrum","volume":"32","author":"Jin CJ","year":"2020","unstructured":"Jin CJ, Berry-Candelario J, Reiner AS,  Long-term outcomes of high-dose single-fraction radiosurgery for chordomas of the spine and sacrum. J Neurosurg Spine. 2020;32(1):79\u201388. doi:10.3171\/2019.7.SPINE19515"},{"issue":"1","key":"b10","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Spinal stereotactic body radiotherapy following intralesional curettage with separation surgery for initial or salvage chordoma treatment","volume":"42","author":"Lockney DT","year":"2017","unstructured":"Lockney DT, Shub T, Hopkins B,  Spinal stereotactic body radiotherapy following intralesional curettage with separation surgery for initial or salvage chordoma treatment. Neurosurg Focus. 2017;42(1):E4. doi:10.3171\/2016.9.FOCUS16373"},{"issue":"1","key":"b11","series-title":"Neurosurg Focus","first-page":"E6","article-title":"The impact of histology and delivered dose on local control of spinal metastases treated with stereotactic radiosurgery","volume":"42","author":"Yamada Y","year":"2017","unstructured":"Yamada Y, Katsoulakis E, Laufer I,  The impact of histology and delivered dose on local control of spinal metastases treated with stereotactic radiosurgery. Neurosurg Focus. 2017;42(1):E6. doi:10.3171\/2016.9.FOCUS16369"},{"issue":"8","key":"b12","series-title":"Cancers (Basel)","first-page":"2359","article-title":"Radiotherapy for mobile spine and sacral chordoma: a critical review and practical guide from the Spine Tumor Academy","volume":"15","author":"Redmond KJ","year":"2023","unstructured":"Redmond KJ, Schaub SK, Lo SFL,  Radiotherapy for mobile spine and sacral chordoma: a critical review and practical guide from the Spine Tumor Academy. 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J Neurosurg Spine. 2021;35(5):674\u2013683. doi:10.3171\/2021.2.SPINE202199"},{"issue":"2","key":"b17","series-title":"Neurosurg Clin N Am","first-page":"263","article-title":"Radiation strategies for spine chordoma: proton beam, carbon ions, and stereotactic body radiation therapy","volume":"31","author":"Konieczkowski DJ","year":"2020","unstructured":"Konieczkowski DJ, DeLaney TF, Yamada YJ. Radiation strategies for spine chordoma: proton beam, carbon ions, and stereotactic body radiation therapy. Neurosurg Clin N Am. 2020;31(2):263\u2013288. doi:10.1016\/j.nec.2019.12.002"},{"issue":"3","key":"b18","series-title":"Neurosurgery","first-page":"494","article-title":"Outcomes after definitive surgery for spinal and sacral chordoma in 101 patients over 20 years","volume":"96","author":"Xia Y","year":"2025","unstructured":"Xia Y, Papali P, Al-Mistarehi AH,  Outcomes after definitive surgery for spinal and sacral chordoma in 101 patients over 20 years. Neurosurgery. 2025;96(3):494\u2013504. doi:10.1227\/neu.0000000000003130"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/45\/4\/article-p622.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/45\/4\/article-p622.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/45\/4\/article-p622.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T14:49:59Z","timestamp":1793976599000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/45\/4\/article-p622.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":18,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2026.2.spine251166","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7,24]]}}}