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Surgical Pearls in Total En Bloc Spondylectomy for Giant Cell Tumor of the Mobile Spine

February 10, 2018

Contributors: Satoru Demura, MD; Satoshi Kato, MD; Hideki Murakami, MD; Norihiro Oku, MD; Takaki Shimizu; Naoki Takahashi, MD; Hiroyuki Tsuchiya, MD; Katsuhito Yoshioka, MD; Noriaki Yokogawa, MD; Noriaki Yokogawa, MD

2018 AWARD WINNER En bloc excision is strongly recommended in patients with a spinal giant cell tumor (GCT) because of the high local recurrence rate associated with intralesional excision. We perform total en bloc spondylectomy (TES) with transpedicular osteotomy with the use of a T-saw, which allows the posterior elements of the spine to be removed en bloc and makes dissection of the spinal cord and nerve roots easier. Although T-saw transpedicular osteotomy often involves an intralesional procedure, we believe that TES with inclusion of the tumor margin will result in curative resection. In a study of 11 patients with a spinal GCT who underwent TES with intralesional T-saw transpedicular osteotomy at our hospital between May 1994 and February 2015, no local tumor recurrence or metastasis had occurred at a mean follow-up of 108 months (range, 24 to 216 months). Concern exists with regard to the highly invasive nature of TES for the management of a spinal GCT; however, the benefits of the surgical procedure must be weighed against the associated perioperative morbidity. Initially, TES often required more than 10 hours of surgery and was associated with blood loss exceeding 2,500 mL. However, the surgical techniques for TES have improved greatly based on knowledge acquired and consideration of surgical anatomy, physiology, and biomechanics of the spine and the spinal cord. In five patients with a spinal GCT who recently underwent TES, intraoperative blood loss was 252 mL ± 171 mL, blood transfusion was not necessary, and no perioperative complications occurred. This video demonstrates current surgical techniques for TES of a spinal GCT, with a focus on safety and reduction of intraoperative blood loss.