Systematic Review and Meta-analysis of En Bloc Vertebrectomy Compared with Intralesional Resection for Giant Cell Tumors of the Mobile Spine
24 September 2015
15 January 2016
07 March 2016 (eFirst)
Study Design Systematic review and meta-analysis.
Objective To compare the recurrence and perioperative complication rate of en bloc vertebrectomy (EV) and intralesional resection (IR) in the giant cell tumor of the mobile spine (SGCT).
Methods We systematically searched publications in the PubMed and Embase databases for reports of SGCTs, excluding the sacrum. Two reviewers independently assessed all publications. A meta-analysis was performed using local recurrence and postoperative complications as the primary outcomes of interest.
Results There were four articles reporting recurrence and two articles reporting postoperative complications. All included articles were case series. In all, 91 patients were included; 49 were treated with IR and 42 were treated with EV. Local recurrence rates were 36.7 and 9.5% in the IR and EV groups, respectively. Rates of postoperative complications were 36.4% with IR and 11.1% with EV. Overall, patients treated with EV not only had a lower recurrence rate (relative risk [RR] 0.22; 95% confidence interval [CI] 0.09 to 0.52) but also had a lower postoperative complication rate (RR 0.34; 95% CI 0.07 to 1.52) compared with IR.
Conclusions Based on the limited data obtained from systematic review, SGCT patients treated with EV had a lower recurrence rate and fewer postoperative complications than those treated with IR.
- 1 Wilartratsami S, Muangsomboon S, Benjarassameroj S, Phimolsarnti R, Chavasiri C, Luksanapruksa P. Prevalence of primary spinal tumors: 15-year data from Siriraj Hospital. J Med Assoc Thai 2014; 97 (9) (Suppl. 09) S83-S87
- 2 Boriani S, Bandiera S, Casadei R , et al. Giant cell tumor of the mobile spine: a review of 49 cases. Spine 2012; 37 (1) E37-E45
- 3 Si MJ, Wang CG, Wang CS , et al. Giant cell tumours of the mobile spine: characteristic imaging features and differential diagnosis. Radiol Med (Torino) 2014; 119 (9) 681-693
- 4 Donthineni R, Boriani L, Ofluoglu O, Bandiera S. Metastatic behaviour of giant cell tumour of the spine. Int Orthop 2009; 33 (2) 497-501
- 5 Martin C, McCarthy EF. Giant cell tumor of the sacrum and spine: series of 23 cases and a review of the literature. Iowa Orthop J 2010; 30: 69-75
- 6 Li G, Fu D, Chen K , et al. Surgical strategy for the management of sacral giant cell tumors: a 32-case series. Spine J 2012; 12 (6) 484-491
- 7 Ming Z, Kangwu C, Huilin Y , et al. Analysis of risk factors for recurrence of giant cell tumor of the sacrum and mobile spine combined with preoperative embolization. Turk Neurosurg 2013; 23 (5) 645-652
- 8 Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73 (9) 712-716
- 9 Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50 (4) 1088-1101
- 10 Sterne JA, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 2001; 54 (10) 1046-1055
- 11 Sterne JA, Egger M, Smith GD. Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. BMJ 2001; 323 (7304) 101-105
- 12 Fidler MW. Surgical treatment of giant cell tumours of the thoracic and lumbar spine: report of nine patients. Eur Spine J 2001; 10 (1) 69-77
- 13 Junming M, Cheng Y, Dong C , et al. Giant cell tumor of the cervical spine: a series of 22 cases and outcomes. Spine (Phila Pa 1976) 2008; 33 (3) 280-288
- 14 Savini R, Gherlinzoni F, Morandi M, Neff JR, Picci P. Surgical treatment of giant-cell tumor of the spine. The experience at the Istituto Ortopedico Rizzoli. J Bone Joint Surg Am 1983; 65 (9) 1283-1289
- 15 Yang SC, Chen LH, Fu TS, Lai PL, Niu CC, Chen WJ. Surgical treatment for giant cell tumor of the thoracolumbar spine. Chang Gung Med J 2006; 29 (1) 71-78
- 16 Sanjay BK, Sim FH, Unni KK, McLeod RA, Klassen RA. Giant-cell tumours of the spine. J Bone Joint Surg Br 1993; 75 (1) 148-154
- 17 Smitherman SM, Tatsui CE, Rao G, Walsh G, Rhines LD. Image-guided multilevel vertebral osteotomies for en bloc resection of giant cell tumor of the thoracic spine: case report and description of operative technique. Eur Spine J 2010; 19 (6) 1021-1028
- 18 Refai D, Dunn GP, Santiago P. Giant cell tumor of the thoracic spine: case report and review of the literature. Surg Neurol 2009; 71 (2) 228-233 , discussion 233
- 19 Rodrigues LM, Nicolau RJ, Puertas EB, Milani C. Vertebrectomy of giant cell tumor with vertebral artery embolization: case report. J Pediatr Orthop B 2009; 18 (2) 99-102
- 20 Samartzis D, Foster WC, Padgett D, Shen FH. Giant cell tumor of the lumbar spine: operative management via spondylectomy and short-segment, 3-column reconstruction with pedicle recreation. Surg Neurol 2008; 69 (2) 138-141 , discussion 141–142
- 21 Li YH, Kour AK, Pho RW. Giant cell tumor of lumbar vertebra. A case report with 13-year followup. Clin Orthop Relat Res 1998; (353) 218-222
- 22 Hunter CL, Pacione D, Hornyak M, Murali R. Giant-cell tumors of the cervical spine: case report. Neurosurgery 2006; 59 (5) E1142-E1143 , discussion E1143
- 23 Lee CG, Kim SH, Kim DM, Kim SW. Giant cell tumor of upper thoracic spine. J Korean Neurosurg Soc 2014; 55 (3) 167-169
- 24 Metkar U, Wardak Z, Katz DA, Lavelle WF. Giant cell tumor of a lumbar vertebra in a 7-year-old child: a case report. J Pediatr Orthop 2012; 32 (8) e76-e80
- 25 Ozaki T, Liljenqvist U, Halm H, Hillmann A, Gosheger G, Winkelmann W. Giant cell tumor of the spine. Clin Orthop Relat Res 2002; (401) 194-201
- 26 Zhou M, Yang H, Chen K , et al. Surgical treatment of giant cell tumors of the sacrum and spine combined with pre-operative transarterial embolization. Oncol Lett 2013; 6 (1) 185-190
- 27 Di Lorenzo N, Spallone A, Nolletti A, Nardi P. Giant cell tumors of the spine: a clinical study of six cases, with emphasis on the radiological features, treatment, and follow-up. Neurosurgery 1980; 6 (1) 29-34
- 28 Xu W, Li X, Huang W , et al. Factors affecting prognosis of patients with giant cell tumors of the mobile spine: retrospective analysis of 102 patients in a single center. Ann Surg Oncol 2013; 20 (3) 804-810