Surgical Outcomes in Patients with High Spinal Instability Neoplasm Score Secondary to Spinal Giant Cell Tumors

Abstract

Study Design Retrospective review. Objective To describe the surgical outcomes in patients with high preoperative Spinal Instability Neoplastic Score (SINS) secondary to spinal giant cell tumors (GCT) and evaluate the impact of en bloc versus intralesional resection and preoperative embolization on postoperative outcomes. Methods A retrospective analysis was performed on 14 patients with GCTs of the spine who underwent surgical treatment prior to the use of denosumab. A univariate analysis was performed comparing the patient demographics, perioperative characteristics, and surgical outcomes between patients who underwent en bloc marginal (n = 6) compared with those who had intralesional (n = 8) resection. Results Six patients underwent en bloc resections and eight underwent intralesional resection. Preoperative embolization was performed in eight patients. All patients were alive at last follow-up, with a mean follow-up length of 43 months. Patients who underwent en bloc resection had longer average operative times (p = 0.0251), higher rates of early (p = 0.0182) and late (p = 0.0389) complications, and a higher rate of surgical revision (p = 0.0120). There was a 25% (2/8 patients) local recurrence rate for intralesional resection and a 0% (0/6 patients) local recurrence rate for en bloc resection (p = 0.0929). Conclusions Surgical excision of spinal GCTs causing significant instability, assessed by SINS, is associated with high intraoperative blood loss despite embolization and independent of resection method. En bloc resection requires a longer operative duration and is associated with a higher risk of complications when compared with intralesional resection. However, the increased morbidity associated with en bloc resection may be justified as it may minimize the risk of local recurrence.

Keywords: Enneking class; SINS score; embolization; en bloc; giant cell tumor; intralesional; spine.

Fig. 1

(a) Preoperative sagittal and (b) coronal nonenhanced computed tomography (CT) scans demonstrating 13.3 × 8.5-cm osteolytic S2–S4 sacral mass with invasion of the sacral foramina and anterior displacement of the sigmoid colon and bladder. (c) Preoperative sagittal T2-weighted magnetic resonance imaging (MRI) demonstrating heterogeneous-appearing mass arising from the sacrum. (d) Preoperative axial gadolinium-enhanced T1-weighted MRI demonstrating sacral mass extending into the pelvis and abutting the rectum. Postoperative (e) lateral and (f) anteroposterior radiographs demonstrating L3–pelvis instrumentation. Postoperative coronal nonenhanced CT scan demonstrating (g) instrumentation and (h) extent of en bloc sacral resection. (i) Postoperative sagittal T2-weighted MRI demonstrating extent of tumor resection.