Giant cell tumor of the cervical spine: a series of 22 cases and outcomes

Abstract

Study design: A consecutive series of 22 giant cell tumor (GCTs) of the cervical spine which underwent surgical treatment was observed from 1990-2003.

Objective: This study reviews the clinical patterns and follow-up data of (GCT) of bone arising in the cervical spine which underwent surgical treatment. We attempt to correlate treatment and outcomes over time.

Summary of background data: GCTs of bone are common, aggressive, or low-grade malignant tumors that occur infrequently in the spine above the sacrum, and their presence in the cervical vertebrae is even more exceptional. Though surgical resection of GCT arising in the cervical spine is commonly regarded as a recommended treatment method, it is still a challenge to achieve satisfactory results, especially for the late or recurrent cases, and there are few large series of cases reported with long-term follow-up of this tumor that are found in special segments in the literature.

Methods: All clinical and follow-up data of 22 cases of GCT arising in cervical spine which received surgical treatment in our spine center from January 1990-December 2003 were collected. The choice of surgical intervention was based on the Weinstein-Boriani-Biagini grading system. Two meanly different protocols of surgical treatment were applied: 8 patients underwent subtotal resection (one of them died shortly after surgery and could not be followed up), 13 cases received total spondylectomy. One special lesion located in the posterior element of C7 received "en bloc" resection. For reconstructing the stability of the cervical spine, we used autologous ilium for pure bone graft, or titanium plate and titanium mesh for anterior instrumented fusion or anterior and posterior combined instrumented fusion. Postoperative radiation therapy was given in 18 cases as an adjunctive therapy method.

Results: One patient with C1-C2 GCT (vertebral body and posterior element involvement) who received subtotal resection of the tumor showed aggravation of neurologic deficit and died shortly after the surgery. So we had 21 cases for mid and long-term follow-up, with an average of 67.8 months, that ranged from 36 to 124 months. The symptom of radicular pain almost disappeared, and patients suffering from spinal cord compression recovered well with at least 1 or 2 levels based on Frankel grading system when re-evaluated at 3 months after operation. The rate of fusion for the bone graft is 100%. All the internal fixations were well fused and no spine instability could be seen in our series. Local recurrence was detected in 5 of 7 cases (71.4%) that underwent subtotal resection, but in only 1 of the 13 cases (7.7%) for total spondylectomy. Four cases died within follow-up and all these patients were recurrent cases. One patient developed pulmonary metastases.

Conclusion: GCT of the cervical spine easily onsets between 20 and 40 years of age. As a kind of benign but local aggressive or low potential malignancy tumor, we should take an aggressive attitude to excise the tumor as much as possible while reserving the neural function as a precondition. Unlike in the thoracic and lumbar spine, a strictly "en bloc" resection is often not a feasible option because of the involvement of critical neurovascular structures. Total spondylectomy (even intralesional) with radiation therapy as an adjunctive treatment has significantly lowered the local recurrence rate of the GCT in the special segments.