Surgical approach selection for total spondylectomy for the treatment of giant cell tumors in the lumbar spine: A retrospective analysis of 12 patients from a single center

Abstract

Aim: To describe the selection of the surgical approach used for total spondylectomy in the treatment of giant cell tumors of the lumbar spine. Methods: This retrospective study included 12 patients with giant cell tumors of the lumbar spine who underwent total spondylectomy. The effect of the Weinstein-Boriani-Biagini surgical staging and tumor location on the approach selected was evaluated. Results: Two tumors were treated using the posterior approach: one located in L1, extending into layers A∼D and involving sectors 2∼6, and the other located in L4, extending into layers B∼D and involving sectors 4∼11. Four tumors (one each located in L1, L2, L3, and L4) were treated by a combined posterior and anterolateral approach as the tumors involved sectors 5∼6 or 7∼8. Six tumors were treated using a combined posterior and anterior approach, two tumors located in L4, extending into layers A∼D and involving sectors 1∼12, and associated with a soft tissue mass extending into layer A and involving sectors 5∼8; and four tumors located in L5. Complications were observed in 9 of the 12 patients. Conclusions: A posterior approach is the obvious strategy for tumors located in L1∼L4 and extending into layers B∼D or A and involving sectors 1∼3 or 10∼12. For tumors invading beyond layer A and involving sectors 1∼12, including those with a soft tissue mass extending from layer A, with involvement of sectors 4∼9, a posterior approach combined with an anterolateral or anterior approach is required. For L5 tumors, a combined posterior and anterior approach is needed.