Giant Cell Tumor in the Spine

Giant cell tumor (GCT) of the spine represents one of the most complex challenges in spinal oncologic surgery. Despite its classification as a benign neoplasm, its locally aggressive behavior, potential for pulmonary metastasis, and high recurrence rate in cases of incomplete resection make it a delicate condition to manage. The tumor’s close anatomical relationship with critical neurovascular structures limits the possibility of extensive oncological resections and increases the risk of neurological complications. Surgical treatment, especially en bloc resection, continues to be the preferred approach for achieving lasting local control, although its practical application depends on tumor location and technical feasibility. In recent years, denosumab has emerged as a key therapeutic agent, offering the possibility of tumor reduction prior to surgery or control in unresectable cases. However, its use is not without complications, especially regarding its influence on tumor architecture and increased local recurrence rates when used as a neoadjuvant therapy. We present a review of the clinical, radiological, histopathological, and therapeutic aspects of spinal GCT. Current surgical strategies, the emerging role of biological treatment with denosumab, and prognostic factors associated with disease progression are discussed. Multidisciplinary experience and management in specialized centers are key to optimizing oncological and functional outcomes in these patients. Level of Evidence V; Retrospective study of case series and literature review.