{"id":"465c55dd-aa6a-47a1-a39e-e4cac9a9a479","slug":"hybrid-therapy-and-use-of-carbon-fiber-reinforced-polyetheretherketone-instrumentation-for-management-of-mobile-spine-chordomas-a-case-series-and-review-of-the-literature","title":"Hybrid therapy and use of carbon-fiber-reinforced polyetheretherketone instrumentation for management of mobile spine chordomas: A case series and review of the literature","authors":["Chi Shing Adrian Lam","Vicente de Paulo Martins Coelho","Seth Wilson","Joshua Palmer","Anas Bardeesi","Vikram Chakravarthy"],"abstract":"Background: Mobile spine chordomas demonstrate varied surgical risk profiles compared to their sacral analogs. Often, the limitation to performing an en bloc resection of a mobile spine chordoma is tumor violation of the epidural space. Given these limitations, we propose the utilization of carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation in separation surgery to enhance visualization for stereotactic body radiation therapy (SBRT) planning, allowing an ablative radiosurgical dose to be delivered. Methods: We present two illustrative cases highlighting the advantages of hybrid therapy (separation surgery and adjuvant SBRT) with CFR-PEEK instrumentation in the management of mobile spine chordoma. Results: Case 1 is a 62-year-old female with an L4 chordoma who underwent separation surgery and L3–5 posterior instrumented fusion using CFR-PEEK instrumentation. Case 2 is a 68-year-old female with a L3 chordoma who underwent revision separation surgery encompassing completion of L3 partial corpectomy and CFR-PEEK screw exchange of prior L2–4 titanium instrumentation. Both patients received postoperative ablative SBRT. At 18-month postoperative time points, both patients were clinically stable, with no signs of tumor recurrence or progression. Conclusion: Mobile spine chordomas present a unique challenge in obtaining a margin negative en bloc resection. Separation surgery allows the ability to decrease surgical morbidity and deliver an ablative radiosurgical dose. Furthermore, the incorporation of CFR-PEEK instrumentation allows the utilization of multiparametric magnetic resonance imaging for long-term disease monitoring. Hybrid therapy, a less morbid alternative to standard en bloc spondylectomy, offers a better surgical morbidity profile by combining effectively with SBRT for optimal tumor control.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/465c55dd-aa6a-47a1-a39e-e4cac9a9a479/featured/hero-1781558730433.png","publishDate":"2025-04-11T00:00:00.000Z","doi":"10.25259/SNI_53_2025","categories":["Neuro-oncology","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/465c55dd-aa6a-47a1-a39e-e4cac9a9a479/pdf"}