Treatments and prognoses for spinal giant cell tumors recurrence after total spondylectomy / 中华骨科杂志

ABSTRACT

Objective To investigate the treatment and prognosis of spinal giant cell tumors recurrence after total spondylectomy.Methods Between February 2001 and February 2016,five female patients suffered from spinal giant cell tumors recurrence after total spondylectomy were retrospectively analyzed.They underwent total spondylectomy with an age ranging from 17 to 63 years old (average 32.6 years).Four cases were primary cases and 1 was recurrent case at the first time of visit.Tumors were located in the thoracic vertebrae in 3 cases,including 1 case in T10 and 2 cases in T11.Tumors were involved in lumbar vertebrae in 2 cases,which were L2 and L5,respectively.According to Tomita spinal tumor classification,all cases were type 5.The Frankel classification for spinal cord injury was grade A in 1 case,grade C in 1 case,grade D in 1 case and grade E in 2 cases.Reoperation was introduced to treat the recurrent tumors after total spondylectomy with adjuvant radiotherapy and drug.The effect of tumor therapy,postoperative complications,nerve function and so on were observed in follow-up.Results One patient was treated with total en bloc spondylectomy (TES) and 4 patients was treated with piecemeal total spondylectomy.The operative approach was onestage posterior approach in 4 patients and combined antero-posterior approach in 1 patient.One patient received radiotherapy and 1 patient was treated with bisphosphonate post operation.The spinal cord function recovered to grade D in 1 patient and grade E in 4 patients.The average interval of recurrence after total spondylectomy was 12-57 months (average 29.6 months).At the second visit,the Frankel classification was grade C in 1 patient.Grade D and grade E were in 2 patients,respectively.Three patients were treated with reoperation to resect the tumors.One patient received radiotherapy and another one was untreated.All 5 patients were followed up with 47-196 months (average 108 months).Four patients survived without tumor and 1 patient without treatment for recurrence survived with tumor.Two patients occurred internal fixation fractures were treated with revision surgery.One of the patients had postoperative spinal canal infection and was cured after internal fixation removal,irrigating and drainage,and antibiotic treatment.The loosening screw in 1 patient was fixed again.Two patients suffered from obvious titanium mesh subsidence (＞ 5 mm).In the last follow-up,there were 1 patients with Frankel grade A,1 with grade D and 3 with grade E.Conclusion Active reoperation combined with radiotherapy and drugs therapy can significantly improve the prognosis of patients with recurrent spinal giant cell tumors after total spondylecmy.