103SProceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S

of 9 (range 5 - 20) years. Only one out of 5 patients in the group with sub-

total resection and direct postoperative radiotherapy had local recurrence

after 11 yrs. There were no major surgical or radiotherapy complications.

The time to recurrence was significantly (11 versus 3 years) longer in the

group that received immediate RT after surgery, even after resection with

irradical margins. There was no difference in overall survival between both

surgical groups.

CONCLUSIONS: The results suggest that postoperative RT is important

in the prevention of local recurrence in patients with sacrococcygeal chor-

doma, even after margin-free tumor resection.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi: 10.1016/j.spinee.2010.07.271

222. Impact of Tumor Histology on Resectability and Neurologic

Outcomes in Primary Intramedullary Spinal Cord Tumors

Isaac O. Karikari, MD1, Shahid M. Nimjee, MD, PhD1,

Tiffany R. Hodges, MD1, Betsy D. Hughes, MD1, Erin Cutrell, BS2,

Ciaran J. Powers, MD, PhD3, Ankit I. Mehta, MD1,

Carlos A. Bagley, MD1, Robert E. Isaacs, MD1,

Michael M. Haglund, MD, PhD1, Allan H. Friedman, MD1; 1Duke

University Medical Center, Durham, NC, USA; 2Rho Inc, Chapel Hill,

NC, USA; 3University of Wisconsin, Madison, WI, USA

BACKGROUND CONTEXT: Intramedullary spinal cord tumors

(IMSCT) are relatively rare tumors. Historically, intraoperative tumor re-

section has been based whether a plane dissection can be identified, which

is often dependent on tumor histology. Ependymomas typically demon-

strate a clear tumor and spinal cord interface whereas astrocytomas exhibit

a more infiltrative pathology. The absence of a clear plane of dissection

leads to subtotal resections of most astrocytomas in many reported studies.

The ability to achieve gross total resection independent of tumor histolog-

ical type in recent reports has brought into question of the role of tumor

histology on the extent of resection. We perform a retrospective analysis

to determine the impact of tumor histology on resectability and functional

neurological outcomes in a consecutive series of IMSCT.

PURPOSE: To analyze factors that have impact on neurological func-

tional outcome in patients who had microsurgical resection of primary in-

tramedullary spinal cord tumors (IMSCT). Characteristics of different

histological tumor entities are described.

STUDY DESIGN/SETTING: Retrospective review.

PATIENT SAMPLE: 104 consecutive patients with IMSCT treated at

a single institution between January 1998-March 2009.

OUTCOME MEASURES: An analysis of functional neurologic status at

time of last follow-up was performed in each tumor subtype based on pre-

operative and postoperative neurological status measured by the modified

McCormick Scale (MMS), presence of intraoperative plane of dissection

(POD), extent of resection (EOR) and recurrence.

METHODS: Clinical, radiographic, operative and pathologic reports were

evaluated for predictors of short and long term neurologic outcomes.

RESULTS: Ependymomas were the most common tumors 55(52.8%),

followed by astrocytomas 21(20.2%), hemangioblastomas 12(11.5%)

and miscellaneous tumors 16(15.3%). Gross total resection (GTR) was

achieved in 50(90.1%) of ependymoma, 3(14.3%) of astrocytoma, 11

(91.7%) of hemangioblastoma and 14(87.5%) of miscellaneous tumors.

Intraoperative plane of dissection was present in 55(98.2%) of ependy-

moma cases, 6(28.6%) of astrocytoma cases, 12(100%) of hemangioblas-

toma cases and 14(87.5%) of miscellaneous tumor cases. At a mean

follow-up of 41 months (1 to 132 months), we observed recurrences in

3(5.4%) ependymoma cases, 11(52.4%) astrocytoma cases, 1(6.3%) of

miscellaneous tumor cases and no recurrence in hemangioblastoma

All referenced figures and tables will be available at the Annual Mee

cases. POD and EOR were predictive of recurrence (p!0.0001). When

analyzed by location, patients with IMSCT in the conus trended towards

neurological improvement or remained stable (95%) compared to cervi-

cal (81.3%) or upper/mid thoracic tumors (81.5%), however this was not

statistically significant (p value50.66). At the time of their last follow-up

visit, 11(19%) of patents with ependymoma improved, 38(67%) re-

mained the same, and 7(12.5%) worsened. In patients with astrocytoma

1(4.8%) improved, 10(47.6%) remained the same and 10 (47.6%) wors-

ened. One (8.3%) patient with hemangioblastoma improved and 11

(91.7%) remained the same. No patient with hemangioblastoma

worsened. In the miscellaneous tumor group, 2(13.3%) improved, 13

(86.7%) remained the same and 1(6.7%) worsened. Age at time of sur-

gery was not predictive of outcome (p value 0.71). Preoperative neuro-

logical status (p50.02), tumor histology (p50.007) and presence of

POD/EOR (p!0.0001) were all predictive of functional neurological

outcomes.

CONCLUSIONS: Tumor histology is the most important predictor of

neurologic outcomes following surgical resection as it predicts resectabil-

ity and recurrence. Gross total resection should be attempted in all IMSCT

cases where a clear plane of dissection is present intraoperatively. Surgical

management of astrocytoma still remains a challenge with significant mor-

bidity despite advances in microsurgical techniques.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi: 10.1016/j.spinee.2010.07.272

223. Analysis of Prognostic Factors in Chordoma Using the

California Cancer Registry

Joe Lee, MD, Nitin Bhatia, MD, Bang Hoang, MD, Argyrios Ziogas, PhD,

Jason Zell, DO, MPH; University of California, Irvine, Orange, CA, USA

BACKGROUND CONTEXT: Chordoma is the most common primary

malignant tumor of the spine. It is extremely rare and has been studied

mostly in single-institution case series. Using data from a large, popula-

tion-based cancer registry, we designed the present study to examine the

outcome of patients with chordoma and relevant prognostic factors.

PURPOSE: To examine the outcome of patients with chordoma and rel-

evant prognostic factors.

STUDY DESIGN/SETTING: Retrospective review of population-based

cancer registry.

PATIENT SAMPLE: 409 patient cases identified 1989–2007.

OUTCOME MEASURES: Chordoma-specific survival.

METHODS: A retrospective analysis of the California Cancer Registry

database was performed to identify chordoma incident patient cases diag-

nosed 1989–2007. Comparisons were made to examine differences in

demographics, disease characteristics, treatment, and survival. Survival

analyses were performed using Kaplan-Meier method with Log Rank tests

and Cox proportional hazards models.

RESULTS: 409 incident patient cases of chordoma were identified, with

257 (62.8%) males, and 152 (37.2%) females. Racial/Ethnic distribution

included 266 (65%) Whites, 7 (1.7%) Blacks, 93 (22.7%) Hispanics, and

45 (10.5%) Asian/Other. For site of presentation, there were 202

(49.4%) cranial, 106 (25.9%) spinal, and 101 (24.7%) pelvic/sacral. His-

panic race (p50.0002), younger age (!40 years; p!0.0001), and female

sex (p50.0092) were associated with cranial presentation; whereas older

age (O70 years; p!0.0001) was associated with pelvic presentation. After

adjusting for clinically relevant factors, a statistically significant decreased

risk of death for chordoma-specific survival was seen with Hispanic race

(HR50.51, 95% CI 0.28–0.93), high socioeconomic status, and surgical

treatment. An increased risk of death was seen in patients with large tumor

size (O5 cm) (HR52.05, 95% CI 1.01–4.20).

ting and will be included with the post-meeting online content.

104S Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S

CONCLUSIONS: This study provides new findings on the survival

patterns of chordoma, with a significantly decreased risk of death seen with

Hispanic race, high socioeconomic status, and surgical excision.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi: 10.1016/j.spinee.2010.07.273

224. Association of Extent of Surgical Resection and Survival in

Patients with Malignant Primary Osseous Spinal Neoplasms:

A 30-Year Population-Based Study

Debraj Mukherjee, MD1, Kaisorn Chaichana, MD1, Scott L. Parker, MD1,

Ziya Gokaslan, MD1, Joseph Cheng, MD2, Matthew McGirt, MD2; 1Johns

Hopkins University School of Medicine, Baltimore, MD, USA; 2Vanderbilt

University, Nashville, TN, USA

BACKGROUND CONTEXT: Malignant primary osseous spinal neo-

plasms are aggressive tumors which remain associated with poor outcomes

despite aggressive treatment. While surgical resection has been shown to

improve short-term local control, it remains debated whether resection is

associated with improved survival.

PURPOSE: Evaluate the role of resection for patients with primary osse-

ous spinal neoplasms.

STUDY DESIGN/SETTING: Retrospective analysis.

PATIENT SAMPLE: SEER registry.

OUTCOME MEASURES: Survival.

METHODS: The SEER registry (1973–2003) was queried to identify cases

of histologically confirmed primary spinal chordoma, chondrosarcoma,

osteosarcoma, or Ewing’s sarcoma via ICD-O-2 coding. Extent of resection

was defined by intra-operative surgeon assessment or radiographic analysis

and classified as biopsy for tissue diagnosis, subtotal resection (STR), or

gross-total resection (GTR). Differentiation between intra-lesional and en-

bloc resection was not made. Association of resection with overall survival

was assessed via Cox proportional-hazards analysis adjusting for age,

radiotherapy, and extent of local tumor invasion.

RESULTS: 827 patients were identified with non-metastatic primary osse-

ous spinal neoplasms (215 Chordoma, 282 Chondrosarcoma, 158 osteosar-

coma, 172 Ewings Sracoma), Table 1. Tumors were more frequently

located in the sacrum/pelvis vs. mobile spine for both surgically resected

(74% vs. 26%) and biopsied lesions (88% vs. 12%). Surgical resection

versus biopsy was associated with improved overall survival independent

of age, radiotherapy, or extent of local tumor invasion for chordoma

[HR, 0.34; p50.05], chondrosarcoma [HR, 0.14; p50.001], and osteosar-

coma [HR, 0.42; p50.005], but not Ewings sarcoma [HR, 0.56; p50.10],

Figure 1. GTR vs. STR was not associated with survival benefit for any

tumor type.

CONCLUSIONS: Surgical resection may play a role in prolonging sur-

vival in the multi-modality treatment of patients with primary spinal chor-

doma, chondrosarcoma, or osteosarcoma demonstrated prolonged overall

survival. The value of surgical resection for Ewings sarcoma may be

limited.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi: 10.1016/j.spinee.2010.07.274

All referenced figures and tables will be available at the Annual Mee

225. Chordoma of the Mobile Spine: A 15-Year Experience at the

Massachusetts General Hospital

Andrew J. Schoenfeld, MD1, Francis X. Pedlow, MD2,

Francis J. Hornicek, MD, PhD2, Joseph H. Schwab, MD, MS2; 1William

Beaumont Army Medical Center/Texas Tech University Health Sciences

Center, El Paso, TX, USA; 2Massachusetts General Hospital,

Boston, MA, USA

BACKGROUND CONTEXT: Chordoma of the spine presents a difficult

surgical challenge. Surgical excision is considered the standard of care, yet

complete excision is not always possible. Several authors have identified

recurrence, metastases and inadequate surgical margins as risk factors

for decreased survival.

PURPOSE: This study sought to describe the epidemiology, treatment and

complications in a series of patients treated with surgery and/or radiation

for spinal chordoma at our institution. We also sought to determine the ef-

fect of type of surgical resection, presence of local recurrence, and metas-

tases on patient outcome.

STUDY DESIGN/SETTING: Retrospective case series at a tertiary aca-

demic referral center.

PATIENT SAMPLE: All cases of chordoma involving the spine located

above the sacrum and below the clivus treated surgically at our institution

between 1992 and 2007.

OUTCOME MEASURES: Survivorship analysis was performed using

Kaplan Meier methodology. Kaplan Meier methodology was also used

to calculate disease specific survival and to compare survival between pa-

tients who had received en-bloc and intralesional resections.

METHODS: Weperformed a retrospective review of cases of chordoma in-

volving the spine located above the sacrum and below the clivus treated sur-

gically at our institution between 1992 and 2007. Medical charts, radiology

reports, pathology reports and operative notes were reviewed for all patients.

Available imaging studies were also examined. Survivorship analysis was

performed using Kaplan Meier methodology. Kaplan Meier methodology

was also used to calculate disease specific survival and to compare survival

between patients who had received en-bloc and intralesional resections. The

effect of type of resection, surgicalmargins, presence of local recurrence, and

metastasis on disease-specific survival were also investigated. Nonparamet-

ric and parametric variables were assessed with the use of the Mann-

Whitney-U statistic, and analysis-of -variance, respectively.

RESULTS: Twenty-six patients were treated surgically for spinal chordoma

in the period under study. Twenty-four were also treated with radiation with

a mean dose of 70 Gy (range 11–101.6). The median overall survival for all

patients in this series was 98.7 months (SE 13.6, 95% CI 72–125). Nine pa-

tients were treated with an en-bloc resection and 8 of these had no evidence

of disease at the time of last evaluation. Eleven of 17 patients treated with

intralesional resections died from disease. Patients treated with en-bloc re-

section had an increased survival compared to those who underwent intrale-

sional excision (p50.002). Similarly, en-bloc resection was associated with

a decreased risk of local recurrence. (p50.02) Eight (31%) patients devel-

oped local recurrences and 3 (11.5%) developed metastasis. Local recur-

rence was associated with a trend toward decreased survival (p50.06).

CONCLUSIONS: En-bloc resection was associated with improved over-

all survival and a reduced risk of local recurrence. There was a trend to-

ward local recurrence having an adverse impact on survival.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi: 10.1016/j.spinee.2010.07.275

ting and will be included with the post-meeting online content.