Chordoma of the lumbar spine – a potential diagnosis not to be forgotten

Chordoma is a rare, malignant neoplasm thought to develop from the notochord. It most commonly occurs in the base of the cranium or the sacro-coccygeal region but around 15-20% affect the vertebral body. Extra-lesional resection with or without adjuvant radiotherapy is generally accepted as the mainstay of treatment for this slow-growing tumour. We present a case whereby a patient with a solitary L3 vertebral body lesion causing caudal compression was treated with spinal decompression and posterior stabilisation. Pre-operative biopsy was not performed as the lesion was presumed to be a metastatic deposit from a co-existing renal mass. Intra-operative biopsy, however, identified the tumour to be chordoma of the L3 vertebral body which would have been more appropriately treated with ‘en-bloc’ excision. This case highlights the importance of pre-operative tissue diagnosis, and that, although rare (0.8 per 100,000), chordoma should always be considered.