Zachary Davis had been dealing with neck and shoulder pain on and off for several years, managing with over-the-counter medications as needed. But one day in February, a roller coaster ride at an amusement park near his home in Los Angeles sent him reeling.
“At the very first turn, it snapped my neck the wrong way, and I was just in all kinds of pain,” he said.
Imaging tests at a nearby emergency hospital revealed a mass on his neck, and he was transferred to a local medical center for treatment.MIR
A rare tumor requiring complex spine surgery
According to spine neurosurgeon Jang Won Yoon, MD, the tumor’s location and its contrast enhancement pattern on MRI scans indicated that it was most likely a rare primary bone cancer called a chordoma. These tumors grow very slowly from notochord cells, which are found in the skeletal structures along the midline of the body during development but should disappear by birth.
“This is a very tough thing to treat,” Yoon said. “By the time it gets discovered, it's huge, and there are a lot of important structures wrapped around the tumor.” Davis’s tumor was pressing on his spinal cord, causing him pain and displacing his esophagus and windpipe.
“The chordoma itself is actually contained inside a balloon, and then the balloon just gets larger and larger, pushing on everything else around it,” Yoon said. “The key thing with this tumor is that you want to remove all of it, if possible, during the initial surgery without violating the capsule.”
Because the tumor had damaged several cervical vertebrae, the initial surgical team in Southern California performed a decompression procedure to relieve pressure on his spinal cord while additional evaluation continued.
Treating these rare tumors often requires coordination among spine surgeons, head and neck surgeons, neurointerventional radiologists and radiation oncologists.
Yoon explained that biopsying a chordoma can increase concerns about tumor cell seeding, which is one reason these tumors are ideally managed with careful surgical planning whenever possible. Chordomas are also often resistant to chemotherapy and conventional forms of radiation therapy — making a complete resection important for reducing the chances of the tumor growing back.
After the mass was confirmed to be a chordoma from the initial surgery, it became clear that definitive treatment would require highly specialized expertise in complex cervical spine tumor surgery.
Finding the right care team
Davis found that expertise at UCSF, where he soon met with Yoon, an expert in complex and minimally invasive spine surgery. “I was constantly being visited by my teams and getting very informative updates,” he said. “It made me feel safe and very happy with the work that was being done.”
To start, Yoon knew that a surgical approach from the front of the spine would provide better access to completely remove the tumor. The vertebral artery was right at the margin of the chordoma, so he then consulted with his colleague, Kazim Narsinh, MD, a UCSF neurointerventional radiologist. They did an angiogram to confirm that sacrificing that blood vessel during surgery would be safe.
Chordomas grow more commonly in the sacrum (the bones at the base of the spine) or the clivus (a bone at the base of the skull). Since Davis’s tumor was high on the cervical spinal cord, Yoon worked closely during the procedure with Ilya Likhterov, MD, a head and neck cancer surgeon who carefully dissected around the nerves in his throat to expose the tumor.
The tumor was removed in one piece, and follow-up imaging showed no visible remaining disease. There remains a risk that it could grow back, but newer types of radiation therapy like proton therapy are showing some promise in slowing recurrence, Yoon says, especially after the entire tumor has been removed.
Today, Davis is completing proton therapy close to home. He's grateful for the coordinated care that allowed him to move from uncertainty to recovery. “It's been a very difficult time, going through all this, but it's been made so much easier just by having people I care about there throughout the whole process,” he said.