Liang Hai-Feng, Xu Hao, Zhan Meng-Na, Xiao Jian, Li Juan, Fei Qin-Ming
Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Department of Orthopaedic Surgery, Shanghai Geriatric Medical Center, Shanghai 201104, China.
World J Clin Cases. 2024 Jun 6;12(16):2894-2903. doi: 10.12998/wjcc.v12.i16.2894.
For patients with acute paraplegia caused by spinal giant cell tumor (GCT) who require emergency decompressive surgery, there is still a lack of relevant reports on surgical options. This study is the first to present the case of an acute paraplegic patient with a thoracic spinal GCT who underwent an emergency total spondylectomy (TES). Despite tumor recurrence, three-level TES was repeated after denosumab therapy.
A 27-year-old female patient who underwent single-level TES in an emergency presented with sudden severe back pain and acute paraplegia due to a thoracic spinal tumor. After emergency TES, the patient's spinal cord function recovered, and permanent paralysis was avoided. The postoperative histopathological examination revealed that the excised neoplasm was a rare GCT. Unfortunately, the tumor recurred 9 months after the first surgery. After 12 months of denosumab therapy, the tumor size was reduced, and tumor calcification. To prevent recurrent tumor progression and provide a possible cure, a three-level TES was performed again. The patient returned to an active lifestyle 1 month after the second surgery, and no recurrence of GCT was found at the last follow-up.
This patient with acute paraplegia underwent TES twice, including once in an emergency, and achieved good therapeutic results. TES in emergency surgery is feasible and safe when conditions permit; however, it may increase the risk of tumor recurrence.
对于因脊柱巨细胞瘤（GCT）导致急性截瘫且需要紧急减压手术的患者，目前仍缺乏关于手术选择的相关报道。本研究首次报道了一例胸椎GCT导致急性截瘫的患者接受了紧急全脊椎切除术（TES）。尽管肿瘤复发，但在地诺单抗治疗后再次进行了三级TES。
一名27岁女性患者因胸椎肿瘤在急诊时接受了单级TES，随后出现突发严重背痛和急性截瘫。紧急TES后，患者脊髓功能恢复，避免了永久性瘫痪。术后组织病理学检查显示切除的肿瘤为罕见的GCT。不幸的是，首次手术后9个月肿瘤复发。地诺单抗治疗12个月后，肿瘤大小缩小且出现肿瘤钙化。为防止复发性肿瘤进展并提供可能的治愈方法，再次进行了三级TES。患者在第二次手术后1个月恢复了积极的生活方式，最后一次随访时未发现GCT复发。
该急性截瘫患者接受了两次TES，其中一次为急诊手术，取得了良好的治疗效果。在条件允许时，急诊手术中的TES是可行且安全的；然而，这可能会增加肿瘤复发的风险。
