Background: Surgery in spine giant cell tumours till date remains the gold standard. However, the morbidity and functional compromise is high due to the close proximity of neurovascular structures deeming them either inoperable or incomplete resections resulting in local recurrences. Denosumab, a monoclonal antibody could play a role as a stand-alone treatment, but also as preoperative treatment or as postoperative after intralesional surgery

Materials and Methods: 17 consecutive patients diagnosed of spine GCT from 3 centres were included. Denosumab usage was categorised either as standalone treatment, preoperative or as post-operative treatment. All patients were administered 120mg subcutaneous monthly doses of Denosumab for the first 6 months. Thereafter the dosing schedule was tailored according to the category. Symptomatic treatment was calculated using VAS scores and the local effect/improvement was staged on imaging. All patients were supplemented with calcium and Vitamin D during treatment.

Results: 3 patients are receiving standalone treatment (8 months - 42 months), 4 was managed with preoperative treatment whereas 10 patients were managed with post operative denosumab treatment. There was no evidence of local recurrence in the preoperative and post operative denosumab treated patients (36 months - 84 months). Recurrences happened in 2 patients after denosumagb therapy and on patient with standalone therapy had a traumatic fracture where tissue diagnosis revealed absence of tumour cells

Conclusion: Denosumab can be used as standalone treatment, preoperatively or as postoperative treatment. Despite many recommendations the dosing schedule and the duration of Denosumab therapy still remains uncertain.