Lumbar chordoma mimicking a neurogenic tumour

Chordomas are rare tumours arising from the primitive notochord along the axial skeleton, typically from the sacrococcygeal region, spheno-occipital region and less commonly, the mobile spine. Midline location associated with bony involvement with extension to the surrounding tissues is the norm. Chordomas presenting laterally, centred within the neural exit foramen and extending to the paraspinal muscles without significant vertebral involvement is rare. We present a 60-year-old woman with lower back pain and radiculopathy. Imaging revealed a unilateral lesion at L4/5 extending through the left neural exit foramen into the paraspinal region. There was only minimal apparent bony involvement. Though these features were highly suggestive of a neurogenic tumour, histopathology revealed the lesion to be a chordoma. Excision of the tumour was performed under neurophysiological monitoring.