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  Indian J Med Microbiol
 

Figure 6: Thoracic chordoma, posterior spondylectomy. A 46-years-old female, presented with paraparesis 12 years before. She had T3-4 chordoma, and had two previous surgeries in 1994, and 2005 in another center. Radiotherapy (46 Gy) also applied. At the time, we evaluated she had no neurological deficits, local swelling at the back. Magnetic resonance images (a and b) and computed tomography scans (c) showed a T3-4 left paravertebral tumor invading 3 ribs, >10 cm diameter. Surgery in December 2005: C6-T7 midline and T-shaped incision (d). Posterior thoracotomy. 3, 4 and 5th ribs resected (e). Ossified tumor was released from the lung aorta by chest surgeons (f). After the right T3 and T4 hemilaminectomy and sacrificing right T3 and T4 roots, right pedicle screws from C7 to T7 and a rod placed. T2 and T3 bodies were released, and two adjacent bodies with tumor and ribs were resected totally (g). Left side screws, rod and a vertebral body cage between T2 and T5 are placed (h). Chest wall defect (appr. 10 cm) was repaired using politetrafloretilen (PTFE) dual mesh (i). A thoracic tube and external lumbar drainage are placed (j). En-bloc specimen and its radiogram show removal of two bodies (k). Duration of surgery was 750 minutes, total bleeding was 1100 ml. She had wound revision surgery one month later. Postoperative radiograms (l) show the construct design. Control magnetic resonance images 1 year after surgery show no remnant tumor (m). She is still alive, has no neurology, no recurrence after 2005 (16 years after en-bloc spondylectomy, 26 years after primary surgery)

Figure 6: Thoracic chordoma, posterior spondylectomy. A 46-years-old female, presented with paraparesis 12 years before. She had T3-4 chordoma, and had two previous surgeries in 1994, and 2005 in another center. Radiotherapy (46 Gy) also applied. At the time, we evaluated she had no neurological deficits, local swelling at the back. Magnetic resonance images (a and b) and computed tomography scans (c) showed a T3-4 left paravertebral tumor invading 3 ribs, >10 cm diameter. Surgery in December 2005: C6-T7 midline and T-shaped incision (d). Posterior thoracotomy. 3, 4 and 5<sup>th</sup> ribs resected (e). Ossified tumor was released from the lung aorta by chest surgeons (f). After the right T3 and T4 hemilaminectomy and sacrificing right T3 and T4 roots, right pedicle screws from C7 to T7 and a rod placed. T2 and T3 bodies were released, and two adjacent bodies with tumor and ribs were resected totally (g). Left side screws, rod and a vertebral body cage between T2 and T5 are placed (h). Chest wall defect (appr. 10 cm) was repaired using politetrafloretilen (PTFE) dual mesh (i). A thoracic tube and external lumbar drainage are placed (j). En-bloc specimen and its radiogram show removal of two bodies (k). Duration of surgery was 750 minutes, total bleeding was 1100 ml. She had wound revision surgery one month later. Postoperative radiograms (l) show the construct design. Control magnetic resonance images 1 year after surgery show no remnant tumor (m). She is still alive, has no neurology, no recurrence after 2005 (16 years after en-bloc spondylectomy, 26 years after primary surgery)