CASE REPORT

37         SA JOURNAL OF RADIOLOGY • September 2006

Abstract

Spinal chordomas in the lumbar region are rare and 
can easily be overlooked in the differential diagnosis of 
vertebral column tumours.

Introduction

Spinal chordomas mostly present in association with 
the clivus or sacrum. We report a case where it was 
overlooked in the differential diagnosis of vertebral col-
umn tumours because it presented in the lumbar spine. 

Case

A 66-year-old male patient presented with a longstand-
ing history of backache, weakness of both legs, constipa-
tion and urinary incontinence; clinically he was tender 
over the lower thoracic and lumbar spine. Conventional 
X-rays showed destruction of the pedicles of L4 and L5. 
On magnetic resonance imaging (MRI) a large mass 
was present, centred around L4. The mass involved 
most of the anterior elements of L4 veretebra and to a 
lesser extent L3 and L5. A large soft-tissue component 
projected anteriorly and paravertebrally, and tumour 
was also filling the spinal canal from L3 to S2. The 
tumour was heterogeneously hypointense on T1 (Fig. 
1), hyperintense with multiple septae on T2 (Figs 2a and 
b) and showed diffuse nodular ring enhancement post 
gadolinium (Fig. 3). Biopsy confirmed a chordoma.

Discussion 

Chordomas are rare tumours originating from rem-
nants of the primitive notochord and may arise any-
where along the spinal vertebral column, being most 
common in a sacral or clival position (85%). Only 6% 

of spinal chordomas originate in the lumbar region. At 
present, MRI is the method of choice for the diagnosis 
and pre-operative assessment.  Chordomas are most 
commonly iso- or hypointense on T1-weighted images, 
and moderately hyperintense on T2-weighted images.1 
Conventional X-rays show irregular and expansile ver-
tebrae as a result of the destructive, slow-growing and 
reactive bone-forming nature of the tumour.2 The 
anterior soft-tissue mass of the involved vertebrae is 
the most important radiological finding and shows 
that prevertebral involvement is greater than osseous 
involvement.3

Lumbar vertebra chordoma 

A Erlank, MB ChB  
J J Parsons, MB ChB 

G Cilliers, MB ChB, MMed Rad (Diag)
O C Schulze, MB ChB

C Ackermann, MB ChB, MMed Rad (Diag),  
MRCS (UK)

H Lameen, MB ChB

Department of Radiology, Tygerberg Hospital and 

Stellenbosch University

Fig. 1. T1 sagittal. Hypointense lobulated soft-tissue mass located in spinal 
canal destroying part of L3 and L5 vertebrae with complete destruction of L4 
vertebra. There is an additional anterior vertebral component and extension 
into the sacral part of the spinal canal.

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CASE REPORT

38         SA JOURNAL OF RADIOLOGY • September 2006

Conclusion

This case demonstrates the typical imaging features of a 
chordoma occurring in a rare location.

1.   Bosma JJ, Pigott TJ, Pennie BH, Jaffray DC. En bloc removal of the lower lumbar vertebrae for chordoma. 
Report of two cases. J Neurosurgery 2001; 94(2 suppl): 284-291.          

2.  Mindell ER. Chordoma. J Bone Joint Surg Am 1981; 63: 501-505.
3.  Sundaresan N. Chordomas. Clin Orthop 1986; 204: 135-142.

Fig. 3. T1 post gadolinium. Moderate inhomogeneous enhancement of the 
soft tissues.

Figs 2a and b. T2 axial (a) and coronal (b). Lobulated hyperintense mass 
infiltrating spinal canal as well as paravertebral muscles.

a

b

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