Chordoma is a rare malignant neoplasm characterized by slow growth and pronounced local aggressiveness. It originates from remnants of the embryonic notochord and demonstrates a predilection for the sacral region.

Chordomas account for approximately 1–4% of all primary bone tumors and nearly 50% of sacral tumors. The disease is frequently diagnosed at an advanced stage due to its indolent course. These tumors exhibit a strong tendency for local invasion of adjacent neurovascular structures, high rates of local recurrence, and potential for distant dissemination. Complete surgical resection with negative margins remains the most important prognostic factor, while responsiveness to conventional radiotherapy and chemotherapy is limited.

We report the case of an 85-year-old patient presenting with progressive low back pain, a palpable sacral mass, and bowel and bladder dysfunction. A combined surgical strategy was implemented, consisting of laparoscopic pelvic tumor mobilization followed by radical partial sacrectomy with bilateral resection of the S3–S5 nerve roots. Histopathological and immunohistochemical analyses confirmed the diagnosis of chordoma with tumor-free resection margins. A delayed reconstructive procedure was subsequently performed. At 3.5-year follow-up, no evidence of local recurrence was observed.