J Neurosurg Spine. 2026;45(4):622-631
Preserving nerve roots does not eliminate the risk of long-term weakness after mobile spine chordoma surgery. Xia and colleagues describe how functional outcomes reflect not only intentional root sacrifice but also neural manipulation, recurrence and other treatment-related events. Their series informs individualized discussions about oncological margins and anticipated disability, without establishing equivalence between surgical strategies.
Study and key findings
This retrospective single-center study included 35 patients with cervical, thoracic or lumbar chordomas, with a median age of 55 years and median follow-up of 5.4 years. Twenty-three resections were Enneking appropriate (EA), defined as en bloc R0 removal with an intact capsule; 12 were Enneking inappropriate (EI), involving intralesional resection or capsule violation.
At last follow-up, motor weakness was present in 11/23 EA patients (47.8%) and 5/12 EI patients (41.7%; p > 0.99). Seven of 19 patients without root sacrifice nevertheless had unplanned long-term weakness. All three patients undergoing sacrifice of roots classified as functionally important developed planned long-term weakness.
Pain improved in 26/31 patients who had preoperative pain, although 21/35 still reported pain at follow-up. Ten patients required surgery for complications. Among the 13 patients with unplanned weakness, the authors attributed five cases to tumor progression; other explanations included neural manipulation, spinal cord infarction, stroke and radiation-related injury.
Interpretation and limitations
The practical decision is whether achieving an intact oncological margin justifies sacrificing a particular neural or vascular structure. In seven EI cases, planned intralesional resection reflected concern about unacceptable morbidity from critical-structure sacrifice.
Treatment selection was not randomized, and the groups differed in anatomy and radiotherapy exposure. Small numbers, retrospective documentation, heterogeneous radiation treatment and absent patient-reported outcomes limit interpretation. A nonsignificant comparison does not demonstrate equal functional or oncological safety. The study’s functional-root classification concerns extremity motor function; it should not imply that other roots have no physiological role.
Clinical takeaway
Discuss the expected deficit from each proposed root sacrifice separately from the broader risk of long-term weakness. Integrate tumor extent, vascular involvement, achievable margins, radiotherapy options and patient priorities into multidisciplinary planning. Root preservation is an important objective, but not a guarantee of preserved function.
You must be logged in to post a comment.