Giant cell tumor of the lumbar spine: operative management via spondylectomy and short-segment, 3-column reconstruction with pedicle recreation

BACKGROUND: Giant cell tumors of the lumbar spine are uncommon lesions. Aggressive management of such lesions via spondylectomy to obtain local control and prevent recurrence is often necessary. Spinal reconstruction after total spondylectomy can be challenging. Traditional reconstructions typically require multisegment fixation with an association loss of segmental motion and limited 3-column reconstruction. METHODS: The authors report a case of a GCT of the lumbar spine occurring in a 49-year-old woman. The authors describe the surgical management of such a lesion via a 1-stage posterior-anterior-posterior procedure that entails a lumbar spondylectomy and short-segment posterior fixation with 3-column reconstruction using a stackable carbon-fiber-reinforced cage device with direct posterior rod connection for pedicle reconstruction. RESULTS: At 33 months postoperative follow-up, neither tumor recurrence nor instrumentation-related complications were noted, bone fusion was prevalent, and sagittal alignment was well maintained. The patient reported no loss of functions, was neurologically intact, and remained active. CONCLUSIONS: Aggressive operative management via spondylectomy of a lumbar GCT provides local tumor control. In select patients, spinal reconstruction after a spondylectomy via a 1-stage posterior-anterior-posterior approach to establish short-segment, 3-column reconstruction with recreation of the pedicles is a promising procedure that provides immediate spinal stabilization without evidence of early instrumentation-related complications, maintains spinal alignment, promotes a quick return to daily activities, and avoids sacrificing excessive motion segments and biomechanical function associated with more traditional procedures.