Vertebral intra-osseous chordoma or giant notochordal rest?

Chordomas of the lumbar vertebral bodies are rare. We report an unusual case of an entirely intraosseous chordoma of the fifth lumbar vertebra treated by vertebrectomy. Conventional radiographs and scintigraphy were normal. The lesion was well visualised by MR imaging, but showed only slight sclerosis on CT. We give our reasons for making a diagnosis of chordoma rather than giant notochordal rest and discuss the problems of management resulting from this diagnostic dilemma.