Surgical strategy for spinal giant cell tumor

English Keywords:Spine  Giant cell tumor  Surgery

English Abstract:

  【Abstract】 Objective：To investigate the surgical strategy for spinal giant cell tumors.Method：41 patients between July 1998 and June 2007 were interviewed retrospectively.There were 20 females and 21 males with the average age of 31 years old（range，17-52 years old）.Cervical，thoracic and lumbar vertebrae were involved in 3，25 and 13 patients respectively.27 patients underwent the primary operation in our hospital，while the other 14 patients were referred to our hospital due to local recurrence.Preoperative segmental artery embolism was performed in 14 patients.Vertebral body involvement was seen in 18 patients and corpectomy and reconstruction by either auto-bone or artificial vertebral body was performed anteriorly.In 16 patients with vertebral body and appendix involvement，combined anterior and posterior approach was used for tumor resection and reconstruction.4 patients with vertebral body and appendix involvement and with no or minor soft tissue involvement underwent spondylectomy en bloc by posterior approach.3 patients with vertebral body and vertebral appendix partial involvement underwent subtotal spondylectomy by posterior approach.Their clinical outcomes were reviewed.Result：The average blood loss for patients undergoing segmental artery embolism was 3100ml，while 4500ml for 27 patients with no segmental artery embolism.Complete tumor resection was not performed in 2 patients due to uncontrolled hemorrhage，as a result，compensatory radiation therapy was given postoperatively，and both of them were still alive till the last follow-up（35 and 29 months respectively）.The other 39 cases were followed up for a mean of 52.9 months.Significantly pain relief was seen in 36 patients.Local recurrence occurred in 16 patients（41%）.Of the 27 patients undergoing the primary operation in our center，9 patients（33.3%） developed local recurrence.11 cases underwent anterior procedure alone，of these，6 cases had recurrence.12 cases underwent combined anterior and posterior procedure，3 cases developed recurrence.4 cases experienced corpectomy en bloc，no recurrence was noted.While as for the 12 cases admitted into our center due to recurrence in other hospital，7 cases（57.1%） developed second recurrence，and 2 cases died of systemic failure.21 patients had been followed up for more than 3 years，and 13 patients had no recurrence.No instrument failure was noted.Conclusion：For spinal giant cell tumor，in order to reduce local recurrence，more aggressive surgery should be considered.