{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T14:26:20Z","timestamp":1784903180785,"version":"3.55.0"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"17","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,10,27]]},"abstract":"\n BACKGROUND<\/jats:title>\n Cervical chordomas offer unique challenges to en bloc resection given their proximity to complex anatomy. Achieving tumor-free margins often requires extensive reconstruction that can limit radiotherapy dosing and postoperative visualization due to metal artifact, compounded by the unavailability of cervical carbon fiber implants. Multidisciplinary multistage approaches focused on oncological resections and maintenance of neurological function can improve quality and quantity of life. The authors present such an approach to the resection of a cervical chordoma with nerve transfer for shoulder reanimation.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 26-year-old woman with cervical myelopathy and upper extremity and trunk weakness and numbness was found to have a cervical chordoma spanning C4\u20137 with severe spinal cord compression. Following balloon test occlusion, resection included (1) posterior decompression of the spinal cord and dorsal dissection of the tumor with spine stabilization, (2) an anterior approach for a vertebral artery\u2013to\u2013superior thyroid artery bypass and ventral dissection, and (3) anterior en bloc resection. Three months postoperatively, a spinal accessory\u2013to\u2013suprascapular nerve transfer was performed. After 6 months, the patient had improved arm function and ambulation.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n A multidisciplinary, staged en bloc resection using carbon fiber\u2013reinforced polymer instrumentation is safe in the cervical spine, with nerve transfers offering improved quality of life.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25367<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25367","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:05:58Z","timestamp":1762214758000},"source":"Crossref","is-referenced-by-count":1,"title":["Cervical chordoma en bloc resection and staged suprascapular nerve transfer reanimation: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0512-6958","authenticated-orcid":true,"given":"Ellen","family":"O\u2019Callaghan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1047-4176","authenticated-orcid":true,"given":"Seeley","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9149-4859","authenticated-orcid":true,"given":"Neill Y.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russel","family":"Kahmke","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Zomorodi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6540-2751","authenticated-orcid":true,"given":"C. Rory","family":"Goodwin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"J Neurooncol","first-page":"173","article-title":"Descriptive epidemiology of chordomas in the United States","volume":"148","author":"Das","year":"2020","unstructured":"Das PSoni PJones JDescriptive epidemiology of chordomas in the United States. J Neurooncol. 2020;148(1):173-178."},{"issue":"3","key":"bib2","series-title":"J Neurosurg","first-page":"702","article-title":"Chordoma incidence, treatment, and survival in the 21st century: a population-based Ontario cohort study","volume":"142","author":"Shakil","year":"2024","unstructured":"Shakil HMalhotra AKEssa AChordoma incidence, treatment, and survival in the 21st century: a population-based Ontario cohort study. J Neurosurg. 2024;142(3):702-711."},{"issue":"11","key":"bib3","series-title":"Oncologist","first-page":"1344","article-title":"Chordoma: the nonsarcoma primary bone tumor","volume":"12","author":"Chugh","year":"2007","unstructured":"Chugh RTawbi HLucas DRBiermann JSSchuetze SMBaker LH.Chordoma: the nonsarcoma primary bone tumor. Oncologist. 2007;12(11):1344-1350."},{"issue":"3","key":"bib4","series-title":"Arch Pathol Lab Med","first-page":"386","article-title":"Chordoma","volume":"146","author":"Ulici","year":"2022","unstructured":"Ulici VHart J.Chordoma. Arch Pathol Lab Med. 2022;146(3):386-395."},{"issue":"22","key":"bib5","series-title":"Spine","first-page":"S48","article-title":"Challenges of local recurrence and cure in low grade malignant tumors of the spine","volume":"34","author":"Boriani","year":"2009","unstructured":"Boriani SSaravanja DYamada YVarga PPBiagini RFisher CG.Challenges of local recurrence and cure in low grade malignant tumors of the spine. Spine. 2009;34(22)(suppl):S48-S57."},{"issue":"1 suppl","key":"bib6","series-title":"Glob Spine J","first-page":"120S","article-title":"Latest developments in targeted biological therapies in the management of chordoma and chondrosarcoma","volume":"15","author":"Biczo","year":"2025","unstructured":"Biczo ASahgal AVerlaan JJLatest developments in targeted biological therapies in the management of chordoma and chondrosarcoma. Glob Spine J. 2025;15(1 suppl):120S-131S."},{"issue":"4","key":"bib7","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","year":"2016","unstructured":"Gokaslan ZLZadnik PLSciubba DMMobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database. J Neurosurg Spine. 2016;24(4):644-651."},{"issue":"2","key":"bib8","series-title":"Glob Spine J","first-page":"191","article-title":"Local and distant recurrence in resected sacral chordomas: a systematic review and pooled cohort analysis","volume":"9","author":"Kerekes","year":"2019","unstructured":"Kerekes DGoodwin CRAhmed AKLocal and distant recurrence in resected sacral chordomas: a systematic review and pooled cohort analysis. Glob Spine J. 2019;9(2):191-201."},{"issue":"6","key":"bib9","series-title":"J Natl Compr Canc Netw","first-page":"688","article-title":"Bone cancer","volume":"11","author":"Biermann","year":"2013","unstructured":"Biermann JSAdkins DRAgulnik MBone cancer. J Natl Compr Canc Netw. 2013;11(6):688-723."},{"issue":"14","key":"bib10","series-title":"J Clin Med","first-page":"4117","article-title":"Cervical paraspinal chordoma: a literature review with a novel case report","volume":"11","author":"Jabbar","year":"2022","unstructured":"Jabbar RJankowski JPawe\u0142czyk ACervical paraspinal chordoma: a literature review with a novel case report. J Clin Med. 2022;11(14):4117."},{"issue":"5","key":"bib11","series-title":"Neurosurg Focus","first-page":"E17","article-title":"Systematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum","volume":"50","author":"Pennington","year":"2021","unstructured":"Pennington ZEhresman JElsamadicy AASystematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum. 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J Neurosurg Spine. 2014;21(3):348-356."},{"issue":"1 suppl","key":"bib14","series-title":"Glob Spine J","first-page":"157S","article-title":"Role of posterior carbon fiber implants in spine tumor surgery","volume":"15","author":"Alvarez-Breckenridge","year":"2025","unstructured":"Alvarez-Breckenridge CANorth RTatsui CRole of posterior carbon fiber implants in spine tumor surgery. Glob Spine J. 2025;15(1 suppl):157S-165S."},{"key":"bib15","series-title":"N Am Spine Soc J","first-page":"100105","article-title":"Attitudes and trends in the use of radiolucent spinal implants: a survey of the North American Spine Society section of spinal oncology","volume":"10","author":"Zavras","year":"2022","unstructured":"Zavras AGSchoenfeld AJPatt JCAttitudes and trends in the use of radiolucent spinal implants: a survey of the North American Spine Society section of spinal oncology. N Am Spine Soc J. 2022;10:100105."},{"issue":"5","key":"bib16","series-title":"Neurosurg Focus","first-page":"E13","article-title":"Carbon fiber\u2013reinforced PEEK instrumentation in the spinal oncology population: a retrospective series demonstrating technique, feasibility, and clinical outcomes","volume":"50","author":"Neal","year":"2021","unstructured":"Neal MTRichards AECurley KLCarbon fiber\u2013reinforced PEEK instrumentation in the spinal oncology population: a retrospective series demonstrating technique, feasibility, and clinical outcomes. Neurosurg Focus. 2021;50(5):E13."},{"issue":"1","key":"bib17","series-title":"J Spine Surg","first-page":"8","article-title":"The use of carbon fiber\/polyetheretherketone (CF\/PEEK) in pedicle screw fixation for spinal neoplasms-potential advantages in postoperative imaging and radiotherapy planning","volume":"10","author":"Ho","year":"2024","unstructured":"Ho DCorde SChen CSaade GBetteridge CMobbs R.The use of carbon fiber\/polyetheretherketone (CF\/PEEK) in pedicle screw fixation for spinal neoplasms-potential advantages in postoperative imaging and radiotherapy planning. J Spine Surg. 2024;10(1):8-21."},{"issue":"4","key":"bib18","series-title":"J Plast Reconstr Aesthet Surg","first-page":"621","article-title":"A systematic review of functional outcomes after nerve reconstruction in extremity soft tissue sarcomas: a need for general implementation in the armamentarium","volume":"73","author":"Martin","year":"2020","unstructured":"Martin EDullaart MJVerhoef CCoert JH.A systematic review of functional outcomes after nerve reconstruction in extremity soft tissue sarcomas: a need for general implementation in the armamentarium. J Plast Reconstr Aesthet Surg. 2020;73(4):621-632."},{"key":"bib19","series-title":"J Plast Reconstr Aesthet Surg","first-page":"523","article-title":"Resect, rewire, and restore: nerve transfer salvage of neurological deficits associated with soft tissue tumors in a retrospective cohort series at a tertiary reconstructive center","volume":"85","author":"Jawad","year":"2023","unstructured":"Jawad AMDuraku LSSusini FResect, rewire, and restore: nerve transfer salvage of neurological deficits associated with soft tissue tumors in a retrospective cohort series at a tertiary reconstructive center. 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J Neurol Surg B Skull Base. 2015;76(4):249-251."},{"issue":"3","key":"bib22","series-title":"J Neurosurg","first-page":"671","article-title":"Vertebral artery transposition for revascularization of the posterior circulation: a critical assessment of temporary and permanent complications and outcomes","volume":"122","author":"Rangel-Castilla","year":"2015","unstructured":"Rangel-Castilla LKalani MYCronk KZabramski JMRussin JJSpetzler RF.Vertebral artery transposition for revascularization of the posterior circulation: a critical assessment of temporary and permanent complications and outcomes. J Neurosurg. 2015;122(3):671-677."},{"issue":"5","key":"bib23","series-title":"Head Neck","first-page":"1455","article-title":"Use of the superior thyroid artery as a recipient artery in head and neck free flap reconstruction: effects on post-operative hypothyroidism","volume":"47","author":"Pak","year":"2025","unstructured":"Pak KYNunez APatel HHo ASMallen-St Clair J.Use of the superior thyroid artery as a recipient artery in head and neck free flap reconstruction: effects on post-operative hypothyroidism. Head Neck. 2025;47(5):1455-1461."},{"issue":"4","key":"bib24","series-title":"J Neurosurg Spine","first-page":"424","article-title":"Multidisciplinary surgical planning for en bloc resection of malignant primary cervical spine tumors involving 3D-printed models and neoadjuvant therapies: report of 2 cases","volume":"30","author":"Ahmed","year":"2019","unstructured":"Ahmed AKPennington ZMolina CAXia YGoodwin CRSciubba DM.Multidisciplinary surgical planning for en bloc resection of malignant primary cervical spine tumors involving 3D-printed models and neoadjuvant therapies: report of 2 cases. J Neurosurg Spine. 2019;30(4):424-431."},{"key":"bib25","series-title":"World Neurosurg","first-page":"e558","article-title":"Impact of multidisciplinary intraoperative teams on thirty-day complications after sacral tumor resection","volume":"152","author":"Schilling","year":"2021","unstructured":"Schilling APennington ZEhresman JImpact of multidisciplinary intraoperative teams on thirty-day complications after sacral tumor resection. World Neurosurg. 2021;152:e558-e566."},{"issue":"6","key":"bib26","series-title":"Cancer Med","first-page":"e70456","article-title":"Perioperative trends in distress among cancer patients: a systematic review and meta-analysis","volume":"14","author":"Rowe","year":"2025","unstructured":"Rowe DGO\u2019Callaghan EYoo SPerioperative trends in distress among cancer patients: a systematic review and meta-analysis. Cancer Med. 2025;14(6):e70456."},{"key":"bib27","series-title":"World Neurosurg","first-page":"316","article-title":"Four-level vertebrectomy for en bloc resection of a cervical chordoma","volume":"118","author":"Aoun","year":"2018","unstructured":"Aoun SGElguindy MBarrie UFour-level vertebrectomy for en bloc resection of a cervical chordoma. World Neurosurg. 2018;118:316-323."},{"issue":"1","key":"bib1","series-title":"J Neurooncol","first-page":"173","article-title":"Descriptive epidemiology of chordomas in the United States","volume":"148","author":"Das","year":"2020","unstructured":"Das PSoni PJones JDescriptive epidemiology of chordomas in the United States. J Neurooncol. 2020;148(1):173-178."},{"issue":"3","key":"bib2","series-title":"J Neurosurg","first-page":"702","article-title":"Chordoma incidence, treatment, and survival in the 21st century: a population-based Ontario cohort study","volume":"142","author":"Shakil","year":"2024","unstructured":"Shakil HMalhotra AKEssa AChordoma incidence, treatment, and survival in the 21st century: a population-based Ontario cohort study. J Neurosurg. 2024;142(3):702-711."},{"issue":"11","key":"bib3","series-title":"Oncologist","first-page":"1344","article-title":"Chordoma: the nonsarcoma primary bone tumor","volume":"12","author":"Chugh","year":"2007","unstructured":"Chugh RTawbi HLucas DRBiermann JSSchuetze SMBaker LH.Chordoma: the nonsarcoma primary bone tumor. Oncologist. 2007;12(11):1344-1350."},{"issue":"3","key":"bib4","series-title":"Arch Pathol Lab Med","first-page":"386","article-title":"Chordoma","volume":"146","author":"Ulici","year":"2022","unstructured":"Ulici VHart J.Chordoma. Arch Pathol Lab Med. 2022;146(3):386-395."},{"issue":"22","key":"bib5","series-title":"Spine","first-page":"S48","article-title":"Challenges of local recurrence and cure in low grade malignant tumors of the spine","volume":"34","author":"Boriani","year":"2009","unstructured":"Boriani SSaravanja DYamada YVarga PPBiagini RFisher CG.Challenges of local recurrence and cure in low grade malignant tumors of the spine. Spine. 2009;34(22)(suppl):S48-S57."},{"issue":"1 suppl","key":"bib6","series-title":"Glob Spine J","first-page":"120S","article-title":"Latest developments in targeted biological therapies in the management of chordoma and chondrosarcoma","volume":"15","author":"Biczo","year":"2025","unstructured":"Biczo ASahgal AVerlaan JJLatest developments in targeted biological therapies in the management of chordoma and chondrosarcoma. Glob Spine J. 2025;15(1 suppl):120S-131S."},{"issue":"4","key":"bib7","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","year":"2016","unstructured":"Gokaslan ZLZadnik PLSciubba DMMobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database. J Neurosurg Spine. 2016;24(4):644-651."},{"issue":"2","key":"bib8","series-title":"Glob Spine J","first-page":"191","article-title":"Local and distant recurrence in resected sacral chordomas: a systematic review and pooled cohort analysis","volume":"9","author":"Kerekes","year":"2019","unstructured":"Kerekes DGoodwin CRAhmed AKLocal and distant recurrence in resected sacral chordomas: a systematic review and pooled cohort analysis. 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J Clin Med. 2022;11(14):4117."},{"issue":"5","key":"bib11","series-title":"Neurosurg Focus","first-page":"E17","article-title":"Systematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum","volume":"50","author":"Pennington","year":"2021","unstructured":"Pennington ZEhresman JElsamadicy AASystematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum. Neurosurg Focus. 2021;50(5):E17."},{"issue":"3","key":"bib12","series-title":"Spine J","first-page":"500","article-title":"Chordoma of the sacrum and mobile spine: a narrative review","volume":"21","author":"Pennington","year":"2021","unstructured":"Pennington ZEhresman JMcCarthy EFChordoma of the sacrum and mobile spine: a narrative review. Spine J. 2021;21(3):500-517."},{"issue":"3","key":"bib13","series-title":"J Neurosurg Spine","first-page":"348","article-title":"Outcomes following attempted en bloc resection of cervical chordomas in the C-1 and C-2 region versus the subaxial region: a multiinstitutional experience","volume":"21","author":"Molina","year":"2014","unstructured":"Molina CAAmes CPChou DOutcomes following attempted en bloc resection of cervical chordomas in the C-1 and C-2 region versus the subaxial region: a multiinstitutional experience. J Neurosurg Spine. 2014;21(3):348-356."},{"issue":"1 suppl","key":"bib14","series-title":"Glob Spine J","first-page":"157S","article-title":"Role of posterior carbon fiber implants in spine tumor surgery","volume":"15","author":"Alvarez-Breckenridge","year":"2025","unstructured":"Alvarez-Breckenridge CANorth RTatsui CRole of posterior carbon fiber implants in spine tumor surgery. 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J Spine Surg. 2024;10(1):8-21."},{"issue":"4","key":"bib18","series-title":"J Plast Reconstr Aesthet Surg","first-page":"621","article-title":"A systematic review of functional outcomes after nerve reconstruction in extremity soft tissue sarcomas: a need for general implementation in the armamentarium","volume":"73","author":"Martin","year":"2020","unstructured":"Martin EDullaart MJVerhoef CCoert JH.A systematic review of functional outcomes after nerve reconstruction in extremity soft tissue sarcomas: a need for general implementation in the armamentarium. J Plast Reconstr Aesthet Surg. 2020;73(4):621-632."},{"key":"bib19","series-title":"J Plast Reconstr Aesthet Surg","first-page":"523","article-title":"Resect, rewire, and restore: nerve transfer salvage of neurological deficits associated with soft tissue tumors in a retrospective cohort series at a tertiary reconstructive center","volume":"85","author":"Jawad","year":"2023","unstructured":"Jawad AMDuraku LSSusini FResect, rewire, and restore: nerve transfer salvage of neurological deficits associated with soft tissue tumors in a retrospective cohort series at a tertiary reconstructive center. J Plast Reconstr Aesthet Surg. 2023;85:523-533."},{"issue":"1","key":"bib20","series-title":"Neurosurgery","first-page":"E245","article-title":"Brachial plexus reconstruction following resection of a malignant peripheral nerve sheath tumor: case report","volume":"69","author":"Spiliopoulos","year":"2011","unstructured":"Spiliopoulos KWilliams Z.Brachial plexus reconstruction following resection of a malignant peripheral nerve sheath tumor: case report. Neurosurgery. 2011;69(1):E245-E250."},{"issue":"4","key":"bib21","series-title":"J Neurol Surg B Skull Base","first-page":"249","article-title":"Combined balloon test occlusion and SPECT analysis for carotid sacrifice: angiographic predictors for success or failure?","volume":"76","author":"Tansavatdi","year":"2015","unstructured":"Tansavatdi KDublin ABDonald PJDahlin B.Combined balloon test occlusion and SPECT analysis for carotid sacrifice: angiographic predictors for success or failure? 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Head Neck. 2025;47(5):1455-1461."},{"issue":"4","key":"bib24","series-title":"J Neurosurg Spine","first-page":"424","article-title":"Multidisciplinary surgical planning for en bloc resection of malignant primary cervical spine tumors involving 3D-printed models and neoadjuvant therapies: report of 2 cases","volume":"30","author":"Ahmed","year":"2019","unstructured":"Ahmed AKPennington ZMolina CAXia YGoodwin CRSciubba DM.Multidisciplinary surgical planning for en bloc resection of malignant primary cervical spine tumors involving 3D-printed models and neoadjuvant therapies: report of 2 cases. 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