Surgical approach selection for total spondylectomy for the treatment of giant cell tumors in the lumbar spine: A retrospective analysis of 12 patients from a single center

Aim To describe the selection of the surgical approach used for total spondylectomy in the treatment of giant cell tumors of the lumbar spine. Methods This retrospective study included 12 patients with giant cell tumors of the lumbar spine who underwent total spondylectomy. The effect of the Weinstein‐Boriani‐Biagini surgical staging and tumor location on the approach selected was evaluated. Results Two tumors were treated using the posterior approach: one located in L1, extending into layers A∼D and involving sectors 2∼6, and the other located in L4, extending into layers B∼D and involving sectors 4∼11. Four tumors (one each located in L1, L2, L3, and L4) were treated by a combined posterior and anterolateral approach as the tumors involved sectors 5∼6 or 7∼8. Six tumors were treated using a combined posterior and anterior approach, two tumors located in L4, extending into layers A∼D and involving sectors 1∼12, and associated with a soft tissue mass extending into layer A and involving sectors 5∼8; and four tumors located in L5. Complications were observed in 9 of the 12 patients. Conclusions A posterior approach is the obvious strategy for tumors located in L1∼L4 and extending into layers B∼D or A and involving sectors 1∼3 or 10∼12. For tumors invading beyond layer A and involving sectors 1∼12, including those with a soft tissue mass extending from layer A, with involvement of sectors 4∼9, a posterior approach combined with an anterolateral or anterior approach is required. For L5 tumors, a combined posterior and anterior approach is needed.