• Eur Spine J · Jul 2023

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

    • Wei Wan, Wei Zheng, Jiongxi Wan, Jie Zhang, Yujie Liu, Qi Jia, Nanzhe Zhong, Jian Zhao, Minglei Yang, Xinghai Yang, and Jianru Xiao.
    • Department of Orthorpedic Oncology, The Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China.
    • Eur Spine J. 2023 Jul 1; 32 (7): 250325122503-2512.

    PurposeAlthough 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.MethodsThis 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.ResultsThe 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.ConclusionSingle-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 EvidenceIV.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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