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An improved total en bloc spondylectomy for L5 vertebral giant cell tumor through a single-stage posterior approach

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Abstract

Purpose

Although total en bloc spondylectomy (TES) is strongly recommended for spinal giant cell tumor (GCT), it is extremely difficult to excise a L5 neoplasm intactly through the single-stage posterior approach. Given the risk of neurological and vascular injury, intralesional curettage (IC) is usually recommended for the treatment of L5 GCT. In this study, we presented our experience with the use of an improved TES to treat L5 GCT through the single-stage posterior approach.

Methods

This study included 20 patients with L5 GCT who received surgical treatment in our department between September 2010 and April 2021. Of them, seven patients received improved TES without iliac osteotomy, and the other 13 patients received IC (n = 8), sagittal en bloc resection (n = 1), TES with iliac osteotomy (n = 3), and TES with radicotomy (n = 1) as control.

Results

The mean operative time was 331.43 ± 92.95 min for improved TES group and 365.77 ± 85.17 min for the control group (p = 0.415), with the mean blood loss of 1142.86 ± 340.87 ml vs. 1969.23 ± 563.30 ml (p = 0.002). Postoperative treatment included bisphosphonates in nine patients and denosumab in 12 patients including one patient who changed from bisphosphonates to denosumab. Three patients who received IC experienced local recurrence, and no relapse was observed in improved TES group.

Conclusion

Single-stage posterior TES for L5 GCT was previously considered impossible. In this study, we presented our experience with the use of an improved surgical technique for L5 TES through the single-stage posterior approach, which has proved to be superior to the conventional procedures in terms of blood loss control and complication and recurrence rates.

Level of Evidence

IV.

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Funding

This study was supported by the Funds of Shanghai Science and Technology Committee (No. 19411962700), Construction project of the most important research center of Shanghai Health Commission (No. 2022ZZ01013), Construction project of Orthopedics Clinical Medical Research Center of Shanghai Science and Technology Committee (No. 21MC1930100), Youth Doctor Assistance Program Funds of Shanghai Changzheng Hospital (YQ664) and Logistics Support Department of PLA (21QNPY044).

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Author notes

  1. Wei Wan, Wei Zheng and Jiongxi Wan have contributed equally.

Authors and Affiliations

  1. Department of Orthorpedic Oncology, The Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China

    Wei Wan, Wei Zheng, Jiongxi Wan, Jie Zhang, Yujie Liu, Qi Jia, Nanzhe Zhong, Jian Zhao, Minglei Yang, Xinghai Yang & Jianru Xiao

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  1. Wei Wan
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Correspondence to Minglei Yang, Xinghai Yang or Jianru Xiao.

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586_2023_7753_MOESM1_ESM.png

Figure 1. Application of the novel L5 TES in a cadaveric model. (A) Titanium rods are bent into the appropriate curvature and fixed to the screws. Then unilateral L4 and S1 screws were lifted alternately to restore the degree of lumbosacral spine lordosis. The L5 vertebra could be removed intactly without osteotomy of the iliac graft. (B) Dissecting the nerve roots up to sufficient length will provide large enough space for rotation of L5 vertebra, without nerve root injury. (C) The surgical field before circumferential reconstruction of L5 vertebra.

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Wan, W., Zheng, W., Wan, J. et al. An improved total en bloc spondylectomy for L5 vertebral giant cell tumor through a single-stage posterior approach. Eur Spine J 32, 2503–2512 (2023). https://doi.org/10.1007/s00586-023-07753-x

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  • DOI: https://doi.org/10.1007/s00586-023-07753-x

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