Recurrent primary lumbar vertebra chondrosarcoma: Marginal resection and Iodine-125 seed therapy
A 54 year old male presented with progressive back pain and lumbar swelling that had gradually increased in size over 3 years. He had undergone an operation for chondrosarcoma in the left transverse process of the third lumbar vertebra 4 years ago in another hospital. Two years prior to admission, he began to have pain in his left leg that radiated from the back and had left paraparesis. Physical examination revealed an 18-cm hard, immobile, round, nontender mass in the posterolateral left flank. Neurological examination showed atrophy of the left quadriceps and hypoesthesia in the left anterolateral thigh.\nPlain radiographs of the LS spine showed inconspicuous calcified points involving the left side of the L3 vertebrae. Computed tomography (CT) showed a mass at L1-5 level, 15 cm in diameter, originating from the left transverse process of L3 [Figure and ]. Lumbar spine magnetic resonance imaging (MRI) demonstrated a large mass lesion, compressing the left nerve root, close to the aorta at the L1-2 levels []. The lesion was completely resected anteroposteriorly, in a piece meal fashion until tumor free margins were obtained. The L3 left remnant transverse process and part of the normal articular process and lamina were removed. The nerve root was free of compression. According to the preoperative plan to which the patient and his family agreed, radioactive Iodine-125 particles with diameters of 0.8 mm, lengths of 4.5 mm and titanium alloy shells were put in gelatin sponges, then they were placed in the bed of the excised lesion. Neurological deficits gradually improved. The pathology specimen was compatible with conventional low-grade chondrosarcoma [].\nTwo years since the operation, the patient remained asymptomatic. Recently obtained X-ray, CT, and MRI show no sign of tumor recurrence [].