Cervical chordoma en bloc resection and staged suprascapular nerve transfer reanimation: illustrative case.

backgroundCervical chordomas offer unique challenges to en bloc resection given their proximity to complex anatomy. Achieving tumor-free margins often requires extensive reconstruction that can limit radiotherapy dosing and postoperative visualization due to metal artifact, compounded by the unavailability of cervical carbon fiber implants. Multidisciplinary multistage approaches focused on oncological resections and maintenance of neurological function can improve quality and quantity of life. The authors present such an approach to the resection of a cervical chordoma with nerve transfer for shoulder reanimation. OBSERVATIONS: A 26-year-old woman with cervical myelopathy and upper extremity and trunk weakness and numbness was found to have a cervical chordoma spanning C4-7 with severe spinal cord compression. Following balloon test occlusion, resection included (1) posterior decompression of the spinal cord and dorsal dissection of the tumor with spine stabilization, (2) an anterior approach for a vertebral artery-to-superior thyroid artery bypass and ventral dissection, and (3) anterior en bloc resection. Three months postoperatively, a spinal accessory-to-suprascapular nerve transfer was performed. After 6 months, the patient had improved arm function and ambulation. LESSONS: A multidisciplinary, staged en bloc resection using carbon fiber-reinforced polymer instrumentation is safe in the cervical spine, with nerve transfers offering improved quality of life. https://thejns.org/doi/10.3171/CASE25367.