Recurrent giant cell tumour of the thoracic spine managed by total en bloc spondylectomy and denosumab therapy: a case report.

BACKGROUND: Giant cell tumour (GCT) of the bone is a rare, invasive benign bone tumour, which typically originates in the metaphyseal ends of long bones and rarely in the spine. Here, we report a rare case of recurrent GCT of the thoracic vertebra, which was managed by three-level total en bloc spondylectomy (TES) after denosumab therapy. CASE PRESENTATION: A 50-year-old woman presented with a 2-month history of progressive lower back pain. Magnetic resonance imaging revealed destruction of the T11 vertebra and a soft tissue mass. The patient underwent tumour resection. Computed tomography at the 2-year follow-up revealed relapse of the resected tumour, which had spread to the T12 vertebral body. Subsequently, denosumab therapy was administered to the patient for 1 year. The growth of the tumour was controlled, and its boundary line was clear. Thereafter, TES for the T10-T12 vertebrae was performed, and spinal reconstruction was completed through a one-stage single posterior approach. The patient's condition improved postoperatively, and no evidence of recurrence of GCT of the bone or spinal deformity was observed at the 32-month follow-up. CONCLUSIONS: Denosumab therapy contributed to tumour regression. Three-level TES may be an effective and feasible strategy for managing large recurrent GCTs of the spine after denosumab therapy.

Is nonstructural bone graft useful in surgical treatment of lumbar spinal tuberculosis?: A retrospective case-control study.

Surgical intervention is an important option for treating spinal tuberculosis. Previous studies have reported different surgical procedures and bone grafts for it. To our knowledge, few studies demonstrated the clinical results of using nonstructural autogenous bone graft in surgical treatment of spinal tuberculosis.The purpose of this study is to compare the clinical outcomes of surgical management lumbar spinal tuberculosis by one-stage posterior debridement with nonstructural autogenous bone grafting and instrumentation versus anterior debridement, strut bone grafting combined with posterior instrumentation.A total of 58 consecutive patients who underwent surgical treatment due to lumbar spinal tuberculosis from January 2011 to December 2013 were included. A total of 22 patients underwent one-stage posterior debridement, nonstructural autogenous bone grafting, and instrumentation (group A), and 36 patients received anterior debridement, strut bone grafting combined with posterior instrumentation (group B). The operative duration, total blood loss, perioperative transfusion, length of hospital stay, hospitalization cost, and complications were recorded. The bony fusion of the graft was assessed by computed tomography scans. American Spinal Injury Association (ASIA) Impairment Scale was used to evaluate the neurological function of patients in the 2 groups.All the patients were followed up, with a mean follow-up duration of 21.6 ±â€Š5.7 months in group A and 22.3 ±â€Š6.2 months in group B (P = 0.47). The average operative duration was 257.5 ±â€Š91.1 minutes in group A and 335.7 ±â€Š91.0 minutes in group B (P = 0.002). The mean total blood loss was 769.6 ±â€Š150.9 mL in group A and 1048.6 ±â€Š556.9 mL in group B (P = 0.007). Also, significant differences were found between the 2 groups in perioperative transfusion volumes, length of hospital stay, and hospitalization cost (P < 0.05), which were less in group A compared with group B. Patients with ASIA grade C/D in the 2 groups were improved with 1 to 2 grades after the surgery with no statistical difference (P = 1.000). The perioperative complications rate was 9.1% (2/22) in group A and 13.9% (5/36) in group B (P = 0.897).Based on a retrospective study, the procedure of one-stage posterior debridement, nonstructural autogenous bone grafting, and instrumentation has a significant shorter operative duration, lower blood loss and perioperative transfusion, shorter hospital stay, and less hospitalization cost compared with the one of anterior debridement, strut bone grafting combined with posterior instrumentation for treating lumber spinal tuberculosis.

Anatomic study of individualized and improved pedicle screw implantation in the lower cervical spine.

The objective of this study was to explore a safe, reliable, and effective method for pedicle screw implantation in the lower cervical spine. Recently, a number of studies have shown that cervical pedicle screw fixation is better than roadside steel plate after cervical screw internal fixation within the scope of its indications. However, the difficulty of the former surgery technology is relatively higher and it is much easier to cause many complications. Therefore, domestic and foreign scholars have been positively exploring safer, easier operations and cheaper methods of pedicle screw implantation in the lower cervical spine. The lower cervical spine areas (C3-C7) of 7 adult cadavers were carried out with computed tomography (CT) scans of 1-mm slices. The entry point, angle, and length of the screws were determined by the measurement of CT images in a picture archiving and communication system. The pedicle screws were implanted with the technique of improved Abumi pedicle screw placement in the lab. The accuracy of the screws was evaluated by the Andrew CT classification criteria of pedicle screw position and gross observation after the experiment. A total of 66 screws were implanted in the lower cervical spine, and 90.9% of the screws inserted were found to be in an optimal position. The method of individualized and improved pedicle screw implantation in the lower cervical spine is relatively safe and reliable, which can be considered to be used in the clinic.