Treatment Of Spinal Giant Cell Tumor Of Bone

Giant cell tumor(GCT) of the spine is a kind of primary borderline tumor occurs on spine.The pathogeny of the tumor is not clear yet,but it is rich in blood supply,invasive growth,and easy recurrence after surgery,and pulmonary metastasis.The incidence of this tumor is not high,about 4.3-12%in giant cell tumor of bone all over the body,about 7.3%in primarily spinal tumor. On gross inspection,these lesions are characteristically chocolate brown,soft, spongy,and friable.Yellowish-to-orange discoloration may be present.Cystic cavities within the tumor are common.Often,these cavities are blood filled, reveals a variable degree of cortical expansion and disruption.Despite the cortical disruption,the periosteum remains intact.Under microscopic lens, multinucleater giant cell well-distributed in bulk round,ellipse or big and fleshy fusiform shape mononuclear interstitial cells,showing evidently karyokinesis, but heteromorphosis is rare.Most patients with giant cell tumor of the spine have the symptom of notalgia.If tumor growth and compress the nervous tissue,corresponding nerve functional disability can be seen.GCTs of the cervical vertebra simultaneously appear respiration,dysphagia and Homer's syndrome.After arteria vertebralis compressed,dizziness and other ischemia symptoms of arteria vertebralis could be seen.GCTs of the sacrum are usually detected late.Patients with sacral GCTs mostly present with localized gas pains and rest pains in the low back or rump, which may radiate to other place.Bladder and sexual function symptoms may also be present.GCTs of the spine show osteolytic expansile focus on X-rays film and CT,and usually have no sclerotic margin and periosteal reaction.Most focus invade into the body of vertebra,growing toward pedicle of vertebral arch and soft tissue,causing collapse of vertebra,rachiterata and spinal cord compression.On Tl weighting magnetic resonance imaging,GCTs show unequable signals from low to middle,high signal area may be presented by chance,which usually indicate new hemorrhage.On T2 weighting magnetic resonance imaging,solid area of tumor presents signal intensity from low to middle.On gtadient echo weighting image,the area could be amplified due to hemosiderin.Cystic areas presents high singnal on T2 weighting magnetic resonance imaging,fluid plane may be presented by chance.GCT of the spine is usually diagnosed by biopsy.The commonly used biopsy methods include percutaneous biopsy,incisional biopsy,excisional biopsy.On account of the complicated topography,GCT of the spine can't be excised easily.So its treatment is a big challenge for a surgeon.In present, clinically used therapy are operation,radiotherapy,continuous artery embolotherapy and chemotherapy.In recent years the concept of compartment and the application of the surgical staging system for spinal tumors have offered very sound basis for evaluating the spinal tumors and guiding the surgeries.The widely used are the WBB and the Tomita classification system,according to these system,surgeons take the advanced surgical techniques,such as wedge-shaped vertebra resection and Total En bloc spondylectomy(TES),most of the spinal tumors can be removed widely or marginally by the edge,the recurrence rate decreased obviously after the surgery.The big development of the biomechanical and the techniques of reconstruction after tumor resection provide guarantees for spinal tumor surgeries.Respect to the therapy of the spinal giant cell tumor of bone,there are two main ways,some experts advocate the wide or marginal removal of the tumor tissues in order to get rid of the recurrence,but this method cost more time of operation and also increase the chance for infection,so more risk in the process, and most of the time the surgeons have to sacrifice affected nerve roots,then the corresponding function lost too.The price paid is bigger.Other experts think in order to preserve the function of the nerves,surgeons should take the conservative intracapsular curettage way,but the recurrence rate is a little high. It is established that En bloc resection with wide margins is the most effective method to lower the recurrence rate of spinal tumors.And if the surgeons are not able to do the marginal removal,it is wise to take the radiology therapy as a assistance to clean the remaining tumor cells.The huge Sacrum giant cell tumor can be treated by consecutive arterial embolization.For those with lung metatasis,they can be controlled by lobectomy and/or chemotherapy.