title: Acute cauda equina syndrome secondary to lumbar chordoma: case report and literature review.
abstract: BACKGROUND
  Chordomas are rare tumors in the craniospinal axis arising from persistent notochordal rests commonly seen in the skull base, including the clivus and the sacrum. Chordomas in the mobile spine occur less commonly. To the best of our knowledge, the clinical presentation of acute cauda equina syndrome (CES) due to chordoma of the lumbar vertebra is not published in the English literature.
  
  
  OBJECTIVE
  To describe an unusual cause of acute CES resulting from chordoma of the lumbar vertebra and discuss management dilemmas in this clinical context.
  
  
  METHODS
  Case report with review and discussion.
  
  
  METHODS
  We report the case of a 75-year-old man who presented with acute CES that was clinically considered a metastasis from his previously documented carcinoma of the urinary bladder treated a year ago. Clinical, radiological, and histopathological features of the case and a review of chordomas in the lumbar vertebrae in adults in the published English literature are presented.
  
  
  RESULTS
  He underwent urgent surgical decompression with laminectomy of L3/L4 and L4/L5 with debulking and open biopsy of the tissue mass. Histopathological examination of the tissue mass confirmed the unsuspected diagnosis of chordoma. The salient features of chordomas in the lumbar vertebrae published in the English literature over the last 22 years are summarized. The origin, classification, clinical presentation, and management protocols for lumbar chordomas are also reviewed.
  
  
  CONCLUSIONS
  The clinical presentation of acute CES as the first symptom of chordoma in the lumbar vertebrae is extremely rare. Preoperative tissue diagnosis of this uncommon pathology is usually unavailable. In the face of acute CES, surgical decompression remains the primary goal of management with a planned definitive second-stage curative surgical resection for chordoma.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Saskatchewan, Royal University Hospital, 103, Hospital Drive, Saskatoon, S7N 0W8, Canada.
authors.forename: Mehala
authors.initials: M
authors.lastname: Tharmabala
authors.forename: Danielle
authors.initials: D
authors.lastname: LaBrash
authors.forename: Rani
authors.initials: R
authors.lastname: Kanthan
mesh_terms: D000368:Aged; D002817:Chordoma / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery; D008297:Male; D011128:Polyradiculopathy / Q000209:etiology* / Q000473:pathology; D013125:Spinal Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
keywords: Acute cauda equina syndrome; Benign notochordal cell tumors; Lumbar chordoma; Malignant chordomas; Management dilemmas