Neurological Recovery in Two Patients with Cauda Equina Syndrome Secondary to L5 Lumbar Spine Giant Cell Tumour after Treatment with Denosumab without Surgery

Abstract

We report two patients with cauda equina syndrome (CES) secondary to L5 giant cell tumour (GCT) who achieved good neurological recovery after treatment with denosumab without surgery. The first patient was a 26-year-old man with L5 GCT causing CES who regained bowel and urinary control, muscle power improvement from grade 2 to grade 4 and Oswestry disability index (ODI) improvement from 48 to 23 after denosumab treatment. The second patient was a 25-year-old woman with L5 GCT causing CES who regained bowel and urinary control, muscle power improvement from grade 0 to grade 4 and ODI improvement from 42 to 20 after denosumab treatment. The usage of denosumab in the treatment of patients with CES due to GCT allows potential neurological recovery without any surgical intervention. If surgery is not contraindicated, more time is obtained to prepare the patient preoperatively to attain safer surgery and to achieve complete tumour clearance.

Diagnosis and Treatment of Lumbar Giant Cell Tumor of the Spine: Update on Current Management Strategies

“…Severe cases of neurologic compression due to SGCT have been reported by Randhawa et al to lead to Cauda Equina Syndrome. Interestingly, full neurologic recovery was obtained in both cases with denosumab treatment alone [26].…”

“…One patient progressed from 4/5 to 5/5 muscle strength and completely regained bowel and bladder control after 2 weeks of treatment. The second patient progressed from 0/5 to 4/5 muscle strength after 3 months of treatment [26]. Yonezawa et al studied the morphologic changes of four GCTS before and after denosumab therapy through an evaluation of CT scans.…”