GCT in the spine above the sacrum represents approximately 0.1% to 0.25% of the bone tumors [4
]. GCT typically arises in the metaphyseal and the epiphyseal regions of the long bones and are most commonly found in the distal femur, proximal tibia and distal radius [5
]. GCT in the spine usually occurs in the vertebral body as opposed to the posterior elements. Its peak incidence is between 30 to 40 years of age. Patients with GCT of the spine most commonly present with pain, especially at the lower back. The diagnosis may be delayed as the first symptom of the back pain is extremely frequent and easily misinterpreted [3
]. These patients may also report the radicular symptoms and the varying degrees of paraplegia or other neurologic symptoms due to the spinal cord compression [4
]. In this case, the patient was an adolescent and complained only of the upper back pain without any neurologic signs. Thus, the imaging of the spine was not obtained on her first visit, and the diagnosis of the tumor was delayed until the weakness of lower extremities was developed. This may be a shortcoming of this case.
Radiographically, the GCT usually manifests as a destructive, osteolytic lesion on the plan films [2
]. They are distinguishable from other bony tumors in that GCT usually has a non-sclerotic and sharply defined border [6
]. The computed tomography and MRI provide information on the extent of the bony involvement and the degree of the marrow and the surrounding soft tissue involvement. Furthermore a histologic analysis of the biopsy specimen is required to render the diagnosis of GCT [7
]. The optimal management of the GCT is a complete tumor resection with wide margins. The management of patients with GCT of the spine is challenging because of its anatomical features [4
]. A wide or marginal excision of the tumor or en bloc resections may result in a lower recurrence rate, but often cause unacceptable neurological impairments [8
]. Because the GCT exhibits a propensity for aggressive local recurrence unlike other benign bone tumors, the patient undergoes a radiation therapy to the tumor resection [4
]. In this case, the patient presented with a tumor which had invaded most of the T2 vertebral body with a severe narrowing of the spinal canal. Thus, a removal of the mass and a fixation of the T1, T3, and T4 pedicle were completion. In addition, there were three treatments of the radiotherapy.
Following the treatments, an early initiation of the SCI-specific rehabilitation regimen is extremely important. It is essential to determine the potential functional outcome of a person after the SCI, when formulating the rehabilitation plan. The functional outcomes are determined based on the level of SCI and the AIS classification [9
]. The present patient showed AIS D before the surgery, which changed to AIS E after the treatments including the surgery, radiation therapy and rehabilitation.
We have presented a rare case of the GCT of the thoracic spine, with well-documented preoperative and postoperative imaging and management. In the clinical practice, the adolescent patients with the upper back pain and neurological change should be clinically evaluated for tumors.