Curettage-based surgery for spinal giant cell tumors (GCTs) often results in high local recurrence. To prevent local recurrence, we routinely perform total en bloc spondylectomy (TES). When TES is anatomically unfeasible (e.g., in patients with prior surgery or cervical cases), we perform total piecemeal spondylectomy (TPS), ensuring adequate tumor margins. We report the long-term outcomes of these strategies over a period of approximately ten years.

We retrospectively reviewed 34 patients with spinal GCTs patients who were treated surgically at our institution between 1994 and 2022. Data included sex, age, tumor level, surgical classification of spinal tumor (SCST), history of prior surgery, preoperative denosumab treatment, surgical procedure (TES or TPS), and time to recurrence. Local tumor recurrence was monitored by computed tomography every 6 months for the first 2 years postoperatively, and annually thereafter. The recurrence-free survival was estimated using the Kaplan-Meier method, and recurrence-free survival rates were calculated at 10 years postoperatively.

The cohort (9 men, 25 women, mean age 33.8 years) presented with tumors located in the cervical (n= 5), thoracic (n=14), and lumbar (n=15) levels. Nine patients (26.5%) had undergone prior surgery at the other institutions. Procedures included 18 TES and 16 TPS. The mean follow-up duration was 118.9 months. Local tumor recurrences occurred in 3 patients (8.8%) at 12, 48, and 72 months after surgery, respectively. The estimated recurrence-free survival was 223.1 months. The recurrence-free survival rates were 88.9%. All three recurrences occurred in patients who underwent TPS for tumors classified as SCST type 6 (tumor involves adjacent vertebrae). Among the 9 patients with a history of prior surgery, 7 underwent TPS, and 1 experienced recurrence.

All 5 cervical cases underwent TPS with zero recurrences. In cases of spinal GCTs, TES provided excellent local control with no recurrences over

10 years. TPS also yielded favorable outcomes in most cases. Even in patients with prior surgeries or anatomically challenging cases such as in cervical spine, total excision with adequate tumor margins should be pursued wherever feasible.