BLOCK RESECTION OF LUMBAR OSTEOBLASTOMA. PRESENTATION OF A CASE AND BIBLIOGRAPHICAL UPDATE

Pedro Luis Bazán,Martín Medina,Nicolás Maximiliano Ciccioli,Álvaro Enrique Borri,Enrique Alcides Casco,Richard Avero Gonzalez

doi:10.1590/s1808-185120181704179649

Pedro Luis Bazán, Martín Medina + Show 4 more

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https://doi.org/10.1590/s1808-185120181704179649

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Abstract

ABSTRACT Objective: To present the clinical case and update the bibliography. Methods: A male patient, 24 years of age, sought treatment for right lumbosciatalgia of 3 years of evolution with topography L5 and motor deficit (M4). The radiograph showed a radiopaque lesion between the fourth and fifth lumbar vertebrae, with right pedicle effacement of L4. The tomography identified a lytic lesion, partially surrounded by sclerosis with a central nest of 3 centimeters in diameter located in the right pedicle with involvement of the transverse apophysis and reaction of the intertransverse space (Enneking 3). It was complemented by magnetic resonance and bone scintigraphy. The percutaneous biopsy guided by tomography yielded a diagnosis of osteoblastoma and foci of necrosis. A radical block resection was performed with clear tumor margins and instrumented stabilization. Results: After the surgical treatment, the patient evolved favorably, reversing the motor deficit. The anatomopathological study of the specimen confirms the preoperative diagnosis. Discussion: Intralesional resection may be an option in Enneking stage 2. In Enneking stage 3, a percutaneous diagnostic biopsy may be useful, and block resection is the preferred definitive treatment. Conclusions: The management of spinal osteoblastoma requires an exhaustive clinical-imaging analysis. Block resection with clear margins is preferred in advanced cases for management and to decrease the risk of recurrence. Level of Evidence IV; Case seriesh.

Highlights

Osteoblastoma (OBL) is a rare benign primary bone tumor that produces primary bone and mainly affects the long bones
A radical block resection was performed with clear tumor margins and instrumented stabilization
We present the case of a male patient, 24 years of age, who sought treatment for right lumbosciatalgia of 3 years of evolution and authorized in writing the anonymous presentation of the case

Summary

Introduction

Osteoblastoma (OBL) is a rare benign primary bone tumor that produces primary bone and mainly affects the long bones. The incidence of OBL is low and the male to female ratio is 2:1. It accounts for 1% of all bone tumors and around 40% are located in the spine, most often involving the posterior elements.[1,2,3] Histologically, they are indistinguishable from the smaller osteoid osteomas (OO). OBL is usually larger than 2 cm in diameter, while OO is 1.5 cm or less. These primary bone cancers (PBC) tend to predominate in the pediatric population during the second decade of life.[2,3]

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