Total spondylectomy for Enneking stage III giant cell tumor of the mobile spine

Abstract

Purpose

We reported the surgical outcomes of total en bloc spondylectomy (TES) with intralesional T-saw transpedicular osteotomy in patients with Enneking stage III spinal giant cell tumors (GCTs).

Methods

The medical records and imaging and pathological studies of 25 consecutive patients with Enneking stage III spinal GCTs undergoing surgery at our institution who were followed for at least 2 years were retrospectively reviewed.

Results

Eight men and 17 women (mean age: 34.2 years, range 16–51 years, at the time of surgery) were included. Six patients underwent previous tumor excision at another hospital, and one patient had a history of denosumab treatment. The GCTs were at the cervical, thoracic, and lumbar levels in three, nine, and 13 patients, respectively. TES was performed in 13 patients; 12 required intralesional pediculotomy. The remaining patients underwent total piecemeal spondylectomy with further intralesional tumor resection. During a mean follow-up of 99.2 months (range 24–216), two patients who underwent total piecemeal spondylectomy had local tumor recurrence, but no patients who underwent TES with intralesional pediculotomy had recurrence. The 2- and 10-year recurrence-free survival rates of patients treated with total piecemeal spondylectomy were 91.7% and 78.6%, respectively, while those of patients treated with TES were both 100%.

Conclusions

TES with intralesional pediculotomy had a good surgical outcome even in patients with Enneking stage III spinal GCT, suggesting that minimal intralesional procedures could radically cure spinal GCTs.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Boriani S, Bandiera S, Casadei R, Boriani L, Donthineni R, Gasbarrini A, Pignotti E, Biagini R, Schwab JH (2012) Giant cell tumor of the mobile spine: a review of 49 cases. Spine (Phila Pa 1976) 371:E37–E45

    Article  Google Scholar 

  2. 2.

    Campanacci M, Baldini N, Boriani S, Sudanese A (1987) Giant-cell tumor of bone. J Bone Joint Surg Am 69:106–114

    CAS  Article  Google Scholar 

  3. 3.

    Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G, Hardes J, Gosheger G (2008) Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol 134:969–978

    CAS  Article  Google Scholar 

  4. 4.

    Luksanapruksa P, Buchowski JM, Singhatanadgige W, Rose PC, Bumpass DB (2016) Management of spinal giant cell tumors. Spine J 16:259–269

    Article  Google Scholar 

  5. 5.

    Elder BD, Sankey EW, Goodwin CR, Kosztowski TA, Lo SF, Bydon A, Wolinsky JP, Gokaslan ZL, Witham TF, Sciubba DM (2016) Surgical outcomes in patients with high spinal instability neoplasm score secondary to spinal giant cell tumors. Glob Spine J 6:21–28

    Article  Google Scholar 

  6. 6.

    Tomita K, Kawahara N, Baba H, Tsuchiya H, Fujita T, Toribatake Y (1997) Total en bloc spondylectomy: a new surgical technique for primary malignant vertebral tumors. Spine (Phila Pa 1976) 22:324–333

    CAS  Article  Google Scholar 

  7. 7.

    Enneking WF (1986) A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res 204:9–24

    Google Scholar 

  8. 8.

    Hart RA, Boriani S, Biagini R, Currier B, Weinstein JN (1997) A system for surgical staging and management of spine tumors. A clinical outcome study of giant cell tumors of the spine. Spine (Phila Pa 1976) 22:1773–1782

    CAS  Article  Google Scholar 

  9. 9.

    Tomita K, Kawahara N, Baba H, Tsuchiya H, Nagata S, Toribatake Y (1994) Total en bloc spondylectomy for solitary spinal metastases. Int Orthop 18:291–298

    CAS  Article  Google Scholar 

  10. 10.

    Harrop JS (2009) Aggressive “benign” primary spine neoplasms. Spine (Phila Pa 1976) 34:S39–S47

    Article  Google Scholar 

  11. 11.

    Xu W, Li X, Huang W, Wang Y, Han S, Chen S, Xu L, Yang X, Liu T, Xiao J (2013) Factors affecting prognosis of patients with giant cell tumors of the mobile spine: retrospective analysis of 102 patients in a single center. Ann Surg Oncol 20:804–810

    Article  Google Scholar 

  12. 12.

    Junming M, Cheng Y, Dong C, Jianru X, Xinghai Y, Quan H, Wei Z, Mesong Y, Dapeng F, Wen Y, Bin N, Lianshun J, Huimin L (2008) Giant cell tumor of the cervical spine: a series of 22 cases and outcomes. Spine (Phila Pa 1976) 33:280–288

    Article  Google Scholar 

  13. 13.

    Luksanapruksa P, Buchowski JM, Singhatanadgige W, Bumpass DB (2016) Systematic review and meta-analysis of en bloc vertebrectomy compared with intralesional resection for giant cell tumors of the mobile spine. Glob Spine J 6:798–803

    Article  Google Scholar 

  14. 14.

    Lewin J, Thomas D (2013) Denosumab: a new treatment option for giant cell tumor of bone. Drugs Today (Barc) 49:693–700

    CAS  Article  Google Scholar 

  15. 15.

    Thomas D, Henshaw R, Skubitz K, Chawla S, Staddon A, Blay JY, Roudier M, Smith J, Ye Z, Sohn W, Dansey R, Jun S (2010) Denosumab in patients with giant-cell tumour of bone: an open-label, phase 2 study. Lancet Oncol 11:275–280

    CAS  Article  Google Scholar 

  16. 16.

    Chawla S, Henshaw R, Seeger L, Choy E, Blay JY, Ferrari S, Kroep J, Grimer R, Reichardt P, Rutkowski P, Schuetze S, Skubitz K, Staddon A, Thomas D, Qian Y, Jacobs I (2013) Safety and efficacy of denosumab for adults and skeletally mature adolescents with giant cell tumour of bone: interim analysis of an open-label, parallel-group, phase 2 study. Lancet Oncol 14:901–908

    CAS  Article  Google Scholar 

  17. 17.

    Rutkowski P, Ferrari S, Grimer RJ, Stalley PD, Dijkstra SP, Pienkowski A, Vaz G, Wunder JS, Seeger LL, Feng A, Roberts ZJ, Bach BA (2015) Surgical downstaging in an open-label phase II trial of denosumab in patients with giant cell tumor of bone. Ann Surg Oncol 22:2860–2868

    Article  Google Scholar 

  18. 18.

    Lin P, Lin N, Teng W, Wang SD, Pan WB, Huang X, Yan XB, Liu M, Li HY, Li BH, Sun LL, Wang Z, Zhou XZ, Ye ZM (2018) Recurrence of giant cell tumor of the spine after resection: a report of 10 cases. Orthop Surg 10:107–114

    Article  Google Scholar 

  19. 19.

    Kumar R, Meis JM, Amini B, McEnery KW, Madewell JE, Rhines LD, Benjamin RS (2017) Giant cell tumor of cervical spine presenting as acute asphyxia: successful surgical resection after down-staging with denosumab. Spine (Phila Pa 1976) 42:e629–632

    Article  Google Scholar 

  20. 20.

    Gaston CL, Grimer RJ, Parry M, Stacchiotti S, Dei Tos AP, Gelderblom H, Ferrari S, Baldi GG, Jones RL, Chawla S, Casali P, LeCesne A, Blay JY, Dijkstra SP, Thomas DM, Rutkowski P (2016) Current status and unanswered questions on the use of Denosumab in giant cell tumor of bone. Clin Sarcoma Res 6:15

    Article  Google Scholar 

  21. 21.

    Broehm CJ, Garbrecht EL, Wood J, Bocklage T (2015) Two cases of sarcoma arising in giant cell tumor of bone treated with denosumab. Case Rep Med 2015:767198

    Article  Google Scholar 

  22. 22.

    Aponte-Tinao LA, Piuzzi NS, Roitman P, Farfalli GL (2015) A high-grade sarcoma arising in a patient with recurrent benign giant cell tumor of the proximal tibia while receiving treatment with denosumab. Clin Orthop Relat Res 473:3050–3055

    Article  Google Scholar 

  23. 23.

    Mak IW, Evaniew N, Popovic S, Tozer R, Ghert M (2014) A translational study of the neoplastic cells of giant cell tumor of bone following neoadjuvant denosumab. J Bone Joint Surg Am 96:e127

    Article  Google Scholar 

  24. 24.

    Yonezawa N, Murakami H, Kato S, Takeuchi A, Tsuchiya H (2017) Giant cell tumor of the thoracic spine completely removed by total spondylectomy after neoadjuvant denosumab therapy. Eur Spine J 26:236–242

    Article  Google Scholar 

  25. 25.

    Matcuk GR, Patel DB, Schein AJ, White EA, Menendez LR (2015) Giant cell tumor: rapid recurrence after cessation of long-term denosumab therapy. Skelet Radiol 44:1027–1031

    Article  Google Scholar 

  26. 26.

    Patil S, Shah KC, Bhojraj SY, Nene AM (2016) Recurrent spinal giant cell tumors: a study of risk factors and recurrence patterns. Asian Spine J 10:129–135

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Hideki Murakami.

Ethics declarations

Conflicts of interest

Noriaki Yokogawa, Hideki Murakami, Satoru Demura, Satoshi Kato, Katsuhito Yoshioka, and Hiroyuki Tsuchiya declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard.

Informed consent

Informed consent was obtained from all individual participants included in the study.

IRB approval

This study was approved by the ethics committee of Kanazawa University (Japan).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 4039 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yokogawa, N., Murakami, H., Demura, S. et al. Total spondylectomy for Enneking stage III giant cell tumor of the mobile spine. Eur Spine J 27, 3084–3091 (2018). https://doi.org/10.1007/s00586-018-5761-3

Download citation

Keywords

  • Giant cell tumor
  • Mobile spine
  • Total en bloc spondylectomy
  • Total piecemeal spondylectomy
  • Tumor resection