Diagnosis and treatment of a C2-osteoblastoma encompassing the vertebral artery

Abstract

Osteoblastoma is a rare, benign bone tumor that accounts for approximately 1% of all primary bone tumors and 5% of spinal tumors, mostly arising within the posterior elements of the spine within the second and third decades of life. Nonspecific initial symptoms mainly neck or back pain and stiffness of the spine remain often undiagnosed and the destructive nature of the expanding tumor can cause even neurological deficits. CT and MRI scans constitute the basic imaging modalities employed in diagnosis and preoperative planning with the former delineating the location and osseous involvement of the mass and the latter providing appreciation of the effect on soft tissues and neural elements. In our case a 23-year-old male presented with persisting head and neck pain, after being involved in a car collision a month ago. Although the initial diagnostic imaging, including plain X-rays and MRI scan failed to reveal any pathological findings, the persistence of the symptoms led to repeating imaging (CT and MRI) that showed the existence of a benign osseous tumor of the C2 lamina that was destructing the surrounding osseous structures and encompassing the right vertebral artery. The suspicion of an osteoblastoma was raised and the decision for surgical removal of the tumor was made for treating the persistent symptoms and preventing a possible neurological deficit or vascular lesion. A marginal tumor resection was performed through a posterior approach, followed by an anterior instrumented fusion. Histological examination confirmed the diagnosis of an osteoblastoma. The recovery of the patient was uneventful and a significant symptom subsidence was reported following surgery. Eighteen months postoperatively the patient remains pain free without any indications for tumor recurrence. This case delineates the difficulties in diagnosing this tumor, as well as the challenges and problems encountered in its surgical management, and also the favorable prognosis when adequately treated.