Giant Cell Tumor of Cervical Spine Presenting as Acute Asphyxia: Successful Surgical Resection After Down-Staging With Denosumab

STUDY DESIGN Case report and literature review. OBJECTIVE To describe treatment of a unique case of acute airway obstruction by a large C7 giant cell tumor (GCT) with preoperative denosumab followed by surgical resection, and review the literature on this rare entity. SUMMARY OF BACKGROUND DATA Standard treatment for GCTs includes surgical resection or curettage and packing. Large lesions in the spine may require preoperative therapy with denosumab, a human monoclonal antibody to RANKL, to facilitate surgery. It is highly unusual for GCT arising in cervical spine to present with acute asphyxia (requiring tracheostomy). METHODS We report a patient with large C7 GCT that caused tracheal compression with almost complete airway obstruction requiring emergency intubation. RESULTS The tumor responded to subcutaneously administered denosumab with marked decrease in size and relief of symptoms. Increased tumor mineralization in response to therapy facilitated subsequent successful surgical tumor resection. The patient remains symptom-free 2 years after surgery without tumor recurrence. CONCLUSION Denosumab can shrink the size of large GCTs, providing symptom relief before surgery and facilitate tumor resection. LEVEL OF EVIDENCE 5.