title: Surgical treatment for giant cell tumor of the thoracolumbar spine.
abstract: BACKGROUND
  Giant cell tumor (GCT) of the bone has historically been regarded as an extremely unpredictable bone tumor. The anatomical characteristics of spinal GCT still present challenges to surgeons. Controversy remains regarding the proper treatment of patients with grade III tumors.
  
  
  METHODS
  Eleven patients with grade III GCT of the thoracolumbar spine were treated between 1992 and 2002 at a medical center by the authors. Three patients were initially treated at other institutions. Adjuvant radiotherapy was employed for local recurrence in these three patients. The other eight patients were initially treated with marginal excision. The site, size, and extent of each lesion dictated the surgical approach.
  
  
  RESULTS
  Five patients had tumor recurrence. One patient, who received radiotherapy, had local relapse with malignant transformation and finally died due to disease-related complications. One patient had a recurrent tumor with multiple metastases throughout the lung. Neurological status, measured using the American Spinal Injury Association scale, of one patient was worse after undergoing the procedure than preoperatively and three patients showed improvement. The other seven patients were classified as with the same grade postoperatively.
  
  
  CONCLUSIONS
  Wide excision of GCT of the thoracolumbar spine is difficult and there is a risk of neurological deficit and spinal instability. Meticulous marginal excision with associated reconstruction may obtain good local control and preserve functional spine. Early detection of recurrent GCT during intensive follow-up can allow for treatment using en bloc excision which has achieved favorable prognoses.
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taipei, ROC.
authors.forename: Shih-Chieh
authors.initials: SC
authors.lastname: Yang
authors.forename: Li-Huei
authors.initials: LH
authors.lastname: Chen
authors.forename: Tsai-Sheng
authors.initials: TS
authors.lastname: Fu
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lai
authors.forename: Chi-Chien
authors.initials: CC
authors.lastname: Niu
authors.forename: Wen-Jer
authors.initials: WJ
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005870:Giant Cell Tumors / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013904:Thoracic Vertebrae; D014057:Tomography, X-Ray Computed