Spinal Osteoblastoma Research Articles

Utility of C arm aided, CT guided, and O arm navigation aids to surgically manage cases of spinal osteoblastoma over a decade

BackgroundSpinal osteoblastoma needs surgical intervention, and over a decade with advancing technologies, different radiological aids have been utilized in the form of CT scan, fluoroscopy and O arm, but no study has compared its efficacy and outcomes. Here, in this case report of three cases, we have compared the intra- and post-operative course and effectiveness of three radiological modalities.Case presentationWe reviewed three surgically treated cases of spinal osteoblastoma with aid of different generation radiological modalities like C arm, CT scan and O arm navigation treated over a span of more than 10 years in single institute by same surgeon. These 3 cases were assessed and compared in terms of intraoperative parameters (image acquisition type, image display, scan time, bone image quality, real-time imaging, radiation exposure, surgical time, blood loss, complications and others) and post-operative parameters (recovery, recurrence and follow-up). First case managed with aid of C arm showed fluoroscopically acquired two-dimensional images, poor bone image quality; higher scan time-surgical time and blood loss with higher radiation exposure and no real-time imaging. Second case managed with aid of CT scan provided three-dimensional images, better bone image quality; lower surgical time and blood loss but increased transport time with minimum radiological exposure to surgeon and OT personnel with no real-time imaging. Third case managed with O arm navigation provided 3-dimensional images, best bone image quality; less surgical time and blood loss with minimum radiological exposure to surgeon and OT personnel with real-time imaging. Additionally, O arm navigation improved accuracy of tumor localization and intraoperative confirmation of complete tumor excision. Whereas all three cases showed no clinico-radiological signs of recurrence on subsequent follow-ups.ConclusionO arm navigation in terms of best bone image quality, accuracy, intraoperative confirmation of tumor excision, surgical time, blood loss and post-operative recovery makes it superior to others.

Intralesional Marginal Resection for Osteoblastoma in the Mobile Spine: Experience From a Single Center.

Osteoblastoma (OB) is a benign bone tumor with aggressive behavior and a tendency for local recurrence. The appropriate surgical strategy for spinal OB remains unclear. This retrospective study aimed to verify the clinical efficacy and safety of intralesional marginal resection of OB in the mobile spine. We enrolled 50 consecutive patients with spinal OB between January 2009 and December 2019. The tumors were staged based on the Enneking system, with 21 and 29 lesions being determined as stage 2 (St.2) and stage 3 (St.3), respectively. Among them, 42 patients underwent intralesional marginal resection, five underwent extensive curettage, and three underwent en bloc resection successfully since their lesions were limited to the posterior element in a single vertebra. We analyzed clinical characteristics, perioperative and follow-up images, surgical details, and follow-up data. Within a median follow-up duration of 50 (range: 24–160) months, six (12.0%) patients had local recurrence. The recurrence rates among patients who underwent intralesional marginal resection, curettage, en bloc resection were 7.1%(3/42), 60.0%(3/5), and 0%(0/3), respectively. The recurrence rate of intralesional marginal resection of St.3 lesions was slightly higher than that of St.2 lesions (7.7%[2/26] vs. 6.3%[1/16]). There were 16(38.1%), 3(60.0%), and 0 patients with surgical complications among those who underwent intralesional marginal resection, curettage, and en bloc resection, respectively. Local recurrence was observed in five (5/14, 35.7%) patients who had vertebral artery extension and in none who did not have vertebral artery extension (p = 0.02). Our findings suggest that intralesional marginal resection could be an appropriate treatment choice for patients with spinal OB, both St.2 and St.3 lesions, with an acceptable local recurrence rate and a low risk of complications. Vertebral artery extension could be a strong risk factor for local recurrence in patients with spinal OB.

Spinal osteoblastoma: a retrospective study of 35 patients\u2019 imaging findings with an emphasis on MRI

ObjectiveTo investigate the values of multimodal imaging approaches in the diagnosis of spinal osteoblastomas with an emphasis on MRI findings.Materials and methodsWe retrospectively evaluated the imaging findings of 35 patients with spinal osteoblastomas. The imaging methods included radiography, whole-body bone scintigraphy (WBBS), CT and MRI.ResultsRadiography detected 87.1% (27/31) of the lesions; WBBS demonstrated increased radionuclide activity in all the lesions. CT could precisely show and localize all niduses, and calcification was always detected. MRI usually could adequately delineate the niduses of osteoblastomas, especially on T2WI (88.2%; 30/34). 71.9% (23/32) of osteoblastomas were surrounded with moderate or extensive bone marrow edema (BME) with soft tissue edema (STE). STE always extended along the muscle bundle adjacent to the lesion; there was no subcutaneous fat involvement. BME was eccentrically distributed in the vertebral body and spread inward from the sides of the nidus. The extent of BME in the vertebral body tended to be inversely proportional to the distance from the nidus. In addition, rare magnifications of osteoblastoma including multifocal diseases (n = 2), vertebra plana (n = 1) or with aneurysmal bone cysts (n = 6) were also observed in our study.ConclusionsIn patients showing moderate or extensive BME together with STE on MRI, both CT and MRI should be used to confirm nidus presence. The above-mentioned characteristics of edema on MRI of patients with spinal osteoblastoma are helpful in not only localizing the nidus, but also enhancing the diagnostic confidence.

Typical and Atypical Radiographic Features of Symptomatic Osteoblastoma in the Spine

Spine osteoblastomas (OBs) are relatively rare. In contrast to osteoid osteoma, radiologic and clinical manifestations of OB can be varied and atypical. Typical radiographic features in spinal OB include peritumoral bone sclerosis, bone marrow edema, and soft tissue edema. Atypical radiographic features include lesions involving ≥3 segments, lesions with extensive (≥3 segments) bone sclerosis, excessive edema (≥3 segments) of soft tissue and bone marrow, no intralesional calcification, and location in the vertebral body only. The aim of this study was to identify typical and atypical features of OB. Pretreatment computed tomography scans and magnetic resonance imaging were reviewed retrospectively. Percutaneous biopsies were performed to confirm pathology in atypical cases. A total of 50 images from patients with diagnosed OB were reviewed. Atypical radiographic features were found in 18 cases (36%). Pathologic diagnosis was confirmed as OB in 86.2% (25/29) cases after percutaneous computed tomography-guided biopsy. Our results show that >30% of spinal OB cases might have atypical radiographic features. In cases with atypical radiographic features, computed tomography-guided biopsies are recommended.

The one-in-all diagnostic value of 99mTc-MDP bone scan combining with single-photon emission tomography (SPECT)/CT imaging in spinal osteoblastoma

BackgroundOsteoblastoma (OB) is an intermediate lesion, which makes the accurate preoperative diagnosis very important. 99mTc-methylene diphosphonate (99mTc-MDP) bone scan and SPECT/CT imaging were evaluated for their diagnostic value in spinal OB.MethodsThis study was a retrospective analysis of patients with spinal OB lesions confirmed by pathology and diagnosed with bone scan and SPECT/CT for preoperative diagnosis from January 2008 to December 2018. The uptake levels of OB on planar bone scan were divided into low, medium, and high groups by visual assessment referring to the uptake of the normal rib, spine, and bladder. X-ray, CT, MRI, bone scan, and SPECT/CT imaging of the patients were analyzed for characteristics summary.ResultsTwenty-five patients were diagnosed for spinal OB (17 males and 8 females with a proportion of 2.1:1), and the average age was 26.8 ± 10.8 years (range 5~59). There were 8 lesions located in the cervical, 6 in the thoracic, and 11 in the lumbar vertebrae. Twenty-four lesions involved posterior elements, especially the pedicles (14/25). Symptoms were predominantly painful with a duration of 18.3 ± 13.9 months (range 0.5~60 months). The lesion size ranged from 9 to 35 mm. All the lesions were low to high uptake in the planar bone scan, and the percentages of low to high levels were 1 (4%), 8 (32%), and 16 (64%) cases.ConclusionsSpinal OB mainly involved the posterior area, and elderly patients should be considered as well. SPECT/CT combined the characteristics of bone uptake and anatomical features of bone tumors, proving its one-in-all diagnostic value for spinal OB and other osteogenic tumors.

Recurrent lumbar-origin osteoblastoma treated with multiple surgery and carbon ion radiotherapy: a case report

BackgroundAlthough osteoblastoma is an uncommon benign bone tumor, it sometimes behaves in a locally aggressive fashion. We herein report a case of recurrent lumbar spine osteoblastoma that was treated by repeated surgery and carbon ion radiotherapy.Case presentationA 13-year-old Japanese girl presented with left side lumbar pain. Computed tomography and magnetic resonance imaging of the lumbar spine demonstrated a tumorous lesion in the left side pedicle of L4. Although gross total resection of the mass, including the nidus, was performed in the initial surgery, recurrence was observed repeatedly in the short term and the pathological diagnosis of all of the resected tumors was conventional osteoblastoma. We finally performed carbon ion radiotherapy after the patient’s 3rd palliative operation, and achieved a good outcome. No further recurrence has been observed in 10 years of follow-up.ConclusionWe performed carbon ion radiotherapy for a case of recurrent spinal osteoblastoma and achieved a good outcome without recurrence at 10 years after carbon ion radiotherapy treatment. To the best of our knowledge, this is the first case of osteoblastoma that was treated with carbon ion radiotherapy after multiple surgeries.

Imaging algorithm and multimodality evaluation of spinal osteoblastoma

BackgroundTo analyze the features of CT, MRI and PET/CT and their diagnostic value for spinal osteoblastomas (OBs).MethodsThe radiological and clinical data of 21 patients with histopathologically-confirmed spinal OBs were analyzed retrospectively.ResultsSixteen of the 21 cases were benign and 5 were aggressive OBs. Tumors were located in the lumbar (n = 11), cervical (n = 4), thoracic (n = 5), and sacral (n = 1) spinal regions. Nineteen cases were centered in the posterior elements of the spine, 13 of which extended into the vertebral body. Punctate or nodular calcifications were found in all cases on CT with a complete sclerotic rim (n = 12) or incomplete sclerotic rim (n = 8). The flare phenomenon (indicative of surrounding tissue inflammation) was found in 17/21 cases on CT, thin in 11 cases and thick in 6 cases, and in 19/19 cases on MRI, thin in 1 case and thick in 18 cases. On 18F-FDG PET/CT, all cases (8/8) were metabolically active with the SUVmax of 12.3–16.0; the flare sign was observed in 8 cases, including 7 cases of hypometabolism and 1 case of coexistence of hypermetabolism and hypometabolism. Based on CT, 3, 12, and 6 cases were classified as Enneking stage 1, 2 and 3, respectively. Of 19 cases with MRI, 1 and 18 cases were classified as Enneking stage 2 and 3, respectively.ConclusionsSpinal OB has multiple unique characteristic radiological features. Although a larger sample size is needed, combining CT, MRI and PET may be beneficial to optimize preoperative diagnosis and care of patients with OBs.

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

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.

Diagnosis and surgical treatment of spinal osteoblastoma

Objective To investigate the clinical charactistics, diagnosis, treatment options and surgical efficacy of spinal osteoblastoma. Methods From May 2007 to May 2016, the clinical manifestations, imaging data, diagnosis, treatment and prognosis of 11 patients with spinal osteoblastoma were retrospectively reviewed. There were 7 males and 4 females. The age ranged from 15 to 44 years old with the average of 27.5 years. Two lesions were involved in cervical spine and 6 lesions were located in thoracic spine. The other 3 cases was in lumbar spine. All patients suffered from local pain. Four patients had neurological deficiency, with 3 suffering radicular pain and 1 suffering incomplete paraplegia (Frankel C). Four patients were staged as Enneking 2 and treated by intralesional curettage. Seven patients were staged as Enneking 3. Accordingly, 4 patients were treated by expanded excision with single posterior approach and 1 patient was treated by expanded excision with combined anterior and posterior approach. The other 2 patients were treated by piecemeal total vertebrectomy with single posterior approach. The pain release, neurological recovery and tumor recurrence were evaluated by postoperative follow-up. Results The mean operation time was 3.5 h (range, 1.5-7 h) and the average intraoperative blood loss was 800 ml (range, 100-3 000 ml). 1 patient had cerebrospinal fluid leakage and 2 patients had pleural effusion. No surgical infection was detected in any patient. After surgery, the pain was dramatically relieved in all patients. The radicular pain in 3 patients were relieved and the incomplete paraplegia in 1 patient was recovered to Frankel E. The mean follow-up period was 45.8 months (range, 12-117 months). Recurrence occurred in 1 case of cervical 7 and thoracic 1 spine leison 4 years after the surgery. Another expanded excision of the tumor was conducted for this patient and no recurrence was detected till now. No other cases of recurrence were observed. No loosing or breakage of implantation was detected during the follow-up. Conclusion For Enneking 2 leisons, intralesional curettage was effective. For Enneking 3 leisons, the expanded excision or piecemeal total vertebrectomy were recommended. No matter the excision was intralesional or not, the satisfactory results could be achieved if complete tumor excision could be conducted. Key words: Spinal neoplasms; Osteoblastoma; Surgical procedures

Clinical, imaging characteristics of benign and aggressive spinal osteoblastoma

Objective To investigate the clinical and imaging manifestations of benign and aggressive spinal osteoblastoma. Methods Seventeen patients with benign osteoblastoma (BO) and 18 patients with aggressive osteoblastoma(AO) from May 2004 to November 2015 diagnosed by orthopedic doctor and pathologist were analyzed retrospectively. Thirty four patients (17 BO, 17 AO) underwent CT plain scanning, 26 patients underwent MRI. The follow-up time was 6 to 96 months, the postoperative recurrence rate was calculated. The continuous variables including the age, the duration of symptoms and the size of tumor were compared between AO and BO with the 2-tailed Student t test or Mann-Whitney U test. The categorical variables were compared between AO and BO with χ2 test.A P value<0.05 was considered statistically significant. Results The age was significantly different between AO and BO [(29.82±14.69) Y vs (19.76±10.33)Y, P 0.05).The recurrence rate of AO (37.50%) was significantly different from that of BO (6.67%, P=0.04). Conclusion The clinical features including the age, duration of symptoms, neurological deficit contributed to differentiating BO from AO. The size of AO was bigger than BO, and AO didn't have intact bony cortex. In the AO group, there was less calcification in the lesion, less edema of bone marrow and adjacent soft tissue around the lesion. The post-operation recurrence of AO was higher than BO. Key words: Spine; Bone neoplasms; Tomography, X-ray computed; Magnetic resonance imaging; Neoplasm recurrence, local

Diagnostic difficulties in the detection of spinal osteoblastoma in a child

Diagnostic difficulties in the detection of spinal osteoblastoma in a child

Surgical management of spinal osteoblastomas.

OBJECTIVE Osteoblastoma is a rare primary benign bone tumor with a predilection for the spinal column. Although of benign origin, osteoblastomas tend to behave more aggressively clinically than other benign tumors. Because of the low incidence of osteoblastomas, evidence-based treatment guidelines and high-quality research are lacking, which has resulted in inconsistent treatment. The goal of this study was to determine whether application of the Enneking classification in the management of spinal osteoblastomas influences local recurrence and survival time. METHODS A multicenter database of patients who underwent surgical intervention for spinal osteoblastoma was developed by the AOSpine Knowledge Forum Tumor. Patient data pertaining to demographics, diagnosis, treatment, cross-sectional survival, and local recurrence were collected. Patients in 2 cohorts, based on the Enneking classification of the tumor (Enneking appropriate [EA] and Enneking inappropriate [EI]), were analyzed. If the final pathology margin matched the Enneking-recommended surgical margin, the tumor was classified as EA; if not, it was classified as EI. RESULTS A total of 102 patients diagnosed with a spinal osteoblastoma were identified between November 1991 and June 2012. Twenty-nine patients were omitted from the analysis because of short follow-up time, incomplete survival data, or invalid staging, which left 73 patients for the final analysis. Thirteen (18%) patients suffered a local recurrence, and 6 (8%) patients died during the study period. Local recurrence was strongly associated with mortality (relative risk 9.2; p = 0.008). When adjusted for Enneking appropriateness, this result was not altered significantly. No significant differences were found between the EA and EI groups in regard to local recurrence and mortality. CONCLUSIONS In this evaluation of the largest multicenter cohort of spinal osteoblastomas, local recurrence was found to be strongly associated with mortality. Application of the Enneking classification as a treatment guide for preventing local recurrence was not validated.

Surgical resection of osteoid osteoma and osteoblastoma of the spine.

III.

CT-guided radiofrequency ablation of spinal osteoblastoma: treatment and long-term follow-up

Objective: Osteoblastoma (OB) is a painful, rare, benign bone tumour usually observed in young populations, and this condition involves the spine in up to one-third of cases. We sought to focus on the minimally invasive treatment of spinal OB with radiofrequency ablation (RFA) under computed tomography (CT) guidance. When performed near the spinal cord, surgery can lead to instability of the spine, sometimes requiring additional interventions to stabilise the segments involved, and can cause the precocious onset of arthrosis or other degenerative diseases.The results were evaluated both clinically and with the aid of diagnostic imaging techniques during a 5-year follow-up study.Materials and methods: Eleven patients affected by spinal OB were treated in a single session with biopsy and CT-guided RFA. Pre- and post-evaluations of the patients were performed both clinically and with CT and magnetic resonance imaging (MRI).Results: Complete success in terms of pain relief was achieved in all patients. Additional treatments were not required in any patients. There were no complications. During follow-up, neither complications nor pathological findings related to the treatment were observed.Conclusions: Our experience demonstrates that RFA for spinal OB is safe and effective. One of the main advantages of this technique is represented by its lower grade of invasiveness compared with that for potentially hazardous surgical manoeuvres.

Surgical Management of Spinal Osteoblastomas

Introduction Primary spinal osteoblastomas are rare benign neoplasms which often behave more aggressively than other benign tumors and can present as malignant transformations. Optimal surgical treatment strategies and risk factors for local recurrence and mortality of spinal osteoblastomas remain unclear. The aim of this multicenter cohort study was to assess rates of local recurrence and mortality following surgical intervention for spinal osteoblastomas and to evaluate whether the application of the Enneking classification in the management of these tumors influences local recurrence and mortality. Methods The AOSpine Knowledge Forum Tumor developed a multicenter ambispective database of patients who underwent surgical intervention for spinal osteoblastoma. Patient demographic, diagnosis, treatment, cross-sectional survival, and local recurrence data were collected. Patients were analyzed in two cohorts based on the Enneking classification of the tumor: Enneking appropriate (EA) and Enneking inappropriate (EI). EA was defined by the final pathology margin matching the Enneking recommended surgical margin, if otherwise, it was defined as EI. Results Between November 1991 and June 2012, a total of 102 patients diagnosed with a spinal osteoblastoma were identified. Twenty-eight patients were omitted from the analysis due to insufficient follow-up (&lt;12 months) or incomplete survival data, leaving 74 patients for final analysis. The mean follow-up was 4.3 ± 2.8 years in the EI and 4.5 ± 3.3 years in the EA group. Thirteen (18%) patients suffered a local recurrence and six (8%) patients died during the study period. Local recurrence was strongly associated with mortality with a relative risk of 9.4 ( p = 0.007). When adjusting for Enneking appropriateness, the result was not significantly altered. Significant differences were not found between the EA and EI groups for local recurrence and mortality. Conclusion Upon evaluating the largest multicenter cohort of spinal osteoblastomas to date, the application of the Enneking classification as treatment guide for spinal osteoblastomas could not be confirmed. Considering the consequences of a local recurrence and the strong association of local recurrence with mortality even after adjusting for Enneking appropriateness, en bloc or marginal resection is nevertheless the recommended surgical treatment strategy for spinal osteoblastoma.

A spinal osteoblastoma in a child, situated in the vertebral body – CT and MR imaging

Objective - To report a rare case of a lumbar spinal osteoblastoma involving only the vertebral body. Case report - A 10-year-old boy presented with low back and leg pain, difficulty walking, limping with his right leg, discreet scoliosis on the left side, and lumbar paraspinal muscle spasms. The Lasegue sign for both sides was positive at around 45 degrees. Babinski's sign and sensory changes were not noted. The boy was evaluated by X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) of the lumbosacral spine. CT and MRI scans revealed an expansile lesion that involved the posterior part of the L4 vertebral body, sparing the posterior osseus elements of the L4 vertebra. The lesion extended into the spinal canal, with compression of the thecal sac and the left L5 nerve root. MR images showed osseus edema of the remainder of the L4 vertebral body, enhanced homogeneously. Peritumoral edema extended into the epidural soft-tissue. Total removal of the tumor was performed. The histopathological finding was an aggressive osteoblastoma. Conclusion - Spinal osteoblastomas are extremely rarely situated in the vertebral body alone. CT and MRI are very important methods for delineation of the location, osseous involvement, peritumoral edema and spread of the tumor in the epidural space, with the possible compression by the tumor of the neural elements of the vertebral canal. Total removal of the osteoblastoma is very important because some osteoblastomas may be aggressive, with a tendency to local recurrence and sometimes metastasis.

Surgical Management of Osteoblastoma of the Spine: Case Series and Review of the Literature.

To describe the demographics, clinical and radiologic presentation, surgical considerations, and clinical outcomes associated with spinal osteoblastoma. A spinal tumor database of 522 patients treated surgically at a single institution between January 2002 and June 2012 was analyzed and five patients with spinal osteoblastoma were identified and included in this study. Basic demographic and epidemiological data were recorded. Tumor characteristics, surgical parameters, and clinical follow-up data were noted. The mean follow-up was 21.9 months. There were four males and one female, and the mean age at diagnosis was 28.4 years. There was a mean reported symptom length of 26.4 months prior to diagnosis. There were three cervical lesions, one lumbar lesion, and one sacrococcygeal lesion. One patient was Enneking stage III and four patients were Enneking stage II. Based on spinal instability neoplastic score criteria, two patients were stable and three patients were potentially unstable. Four patients had intralesional gross total resections and one patient had an en bloc marginal resection. All patients remained neurologically stable or improved postoperatively. A single patient had recurrence of a previously resected osteoid osteoma with progression to osteoblastoma. Aggressive surgical resection of spinal osteoblastoma is suggested to minimize the risk of tumor recurrence, although this may still occur even with en bloc resection. Patients rarely present with preoperative spinal instability, but surgical fusion is often required due to removal of structural elements of the spine during resection. Of note, osteoid osteoma may progress to osteoblastoma in the spine despite prior resection.

Natural History of Untreated Osteoblastoma: A Case Report.

Osteoblastoma is a rare bone-forming tumor constituting about 1% of all bone tumors; it most frequently involves the spine in young patients1-3. Most osteoblastomas are active benign lesions, although they rarely may be characterized as being aggressive or even malignant4,5. Osteoblastomas are distinguished from the closely related osteoid osteoma, which has similar radiographic and histological appearances, predominantly by their size and behavior. Osteoid osteomas run a self-limited course, do not enlarge in size over time, eventually become indolent even when untreated, and are considered by some to be disappearing bone tumors; osteoblastomas are larger lesions that are also distinguished by their unique potential for enlargement1,6-8. We present a case of spinal osteoblastoma that did not have any therapeutic intervention over a five-year period; over this time, there was very little radiographic progression other than an osteoblastic response. The literature documents the aggressive course of this disease, but there are few reports that describe the natural history of an untreated case of osteoblastoma1,9,10. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A thirty-nine-year-old man presented with symptoms of sharp, persistent, and constant midline posterior thoracic pain of insidious onset and moderate strength that sometimes awakened him from sleep but did not radiate. The pain was aggravated by weight-bearing, lifting, and movement; it was partially alleviated with over-the-counter pain medications. By the patient’s estimation, it overlapped in nature and severity with some residual pain from a previous, and mostly thought to be irrelevant, lifting injury two years before, for which he had sought chiropractic assistance and had experienced temporary relief. No radiographs had been obtained at that time. The pain was not …

Clinical features and surgical management of spinal osteoblastoma: a retrospective study in 18 cases.

ObjectivesTo investigate the clinical manifestation and surgical outcome of spinal osteoblastoma.MethodsFrom June 2006 to July 2011, 18 patients with spinal osteoblastoma treated surgically were analyzed retrospectively. There were 11 males and 7 females with an average age of 27.5 years（range, 16-38 years). The tumors were located at C5 in 7, C6 in 6, C7 in 3, C6-T1 1 in 1 and T11 in 1. Based on WBB classification, 16 were 1-3 or 10-12 and 2 were 4-9 and 1-3. 18 operations had been performed with en bloc resection. A posterior approach was used for 16 patients, and a combined posterior and anterior approach was used for 2 patients. Reconstruction using instrumentation and fusion was performed using spinal instrumentation in 13 patients. We used visual analogue scales (VAS) to evaluate the change of pain before and after the operation, and the McCormick System to assess functional status of the spine. Imaging test was used to review the stability and recurrence rate of spine cord, and the confluence of graft bones.ResultsAll cases were followed up for 24-80 months (average, 38.4 months). The average surgical time was 120.8 minutes (range, 80-220 minutes), with the average intraoperative blood loss of 520 ml (range, 300-1200 ml). During the follow-up period, the VAS grade reduced from 6.46±1.32 to 2.26±1.05 (P <0.05). 15 patients had neurological function improved and 3 remained no change which was evaluated by McCormick scale for spinal function status at final follow-up.ConclusionsSpinal osteoblastoma has its own specific radiographic features. There is some recurrence in simple curettage of tumor lesion. The thoroughly en bloc resection of tumor or spondylectomy, bone fusion and strong in Ter fixation are the key points for successful surgical treatment.

Clinical manifestation and surgical treatment of spinal osteoblastoma

To investigate the clinical manifestation and surgical outcome of spinal osteoblastoma. From June 2006 to July 2010, 11 patients with spinal osteoblastoma treated surgically were analyzed retrospectively. There were 7 males and 4 females with an average age of 23.5 years (range, 16 - 34 years). The tumors were located at C(5) in 3, C(6) in 4, C(7) in 2, C(6) ~ T(1) in 1 and T(11) in 1. Based on WBB classification, 9 were 1 - 3 or 10 - 12 and 2 were 4 - 9 and 1 - 3. All the operations had been performed with en-bloc resection. The posterior approach was used for 9 patients, and combined posterior and anterior approach was used for 2 patients. Reconstruction using instrumentation and fusion was performed using spinal instrumentation in 8 patients. To evaluate the change of pain before and after the operation by visual analogue scales (VAS), and to assess functional status of the spine by McCormick scale. Imaging test was used to review the stability and recurrence rate of spine cord, and the confluence of graft bones. All cases were followed up for 12 - 64 months (average, 28.4 months). The average surgical time was 130.5 minutes (range, 90 - 210 minutes), with the average intraoperative blood loss of 560 ml (range, 300 - 1000 ml). During the follow-up period, the VAS grade reduced from 6.3 ± 1.1 to 2.5 ± 1.0 (t = 8.48, P < 0.05). There were 8 patients had neurological function improved and 3 remained no change which was evaluated by McCormick scale for spinal function status at final follow-up. Spinal osteoblastoma has its own specific radiographic feature. There are some recurrence in simple curettage of tumor lesion. The thoroughly en-bloc resection of tumor or spondylectomy, bone fusion and strong in ter fixation are the key points for successful surgical treatment.