Benign intraspinal osteoblastoma stemming from C7 lamina in cervicothoracic junction: a case report

Treatment of osteoblastoma at C3-4 in a child: a case report

Background

Osteoblastoma is a rare and benign osteoid-producing primary bone tumor that affects mainly the long bones. 36% of these tumors are observed around the spine and the vast majority arises around the posterior.

Case presentation

This report describes a case of C3-4 osteoblastoma occurring in a 5-year-and-8-month-old Han Chinese child. The pathophysiology of symptom development, evaluations, and management are presented. Because of the close proximity of the osteoblastoma to the vertebral artery canal, the artery suffered a minor laceration intraoperatively. Hemostatic gelatin sponges were used to compress the bleeding site instantly and a tricortical iliac crest fixed with a screw was also used to add pressure to the gelatin sponges. Fusion on the other side was also used to stabilize the spine. To the best of our knowledge, this is the first report of a case of osteoblastoma at C3-4 with artery injury intraoperatively.

Conclusions

This case delineates the difficulties in diagnosing this tumor, the challenges and problems encountered during its surgical management, and the favorable prognosis after adequate treatment.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2474-15-313) contains supplementary material, which is available to authorized users.

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

OBJECTIVES

To investigate the clinical manifestation and surgical outcome of spinal osteoblastoma.

METHODS

From 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.

RESULTS

All 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.

CONCLUSIONS

Spinal 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.

Osteoblastoma of the third cervical vertebra in a 16-year-old boy: case report and review of the literature

BACKGROUND/SUBJECT: A rare case of osteoblastoma of the third cervical vertebra (C3) occurring in a 16-year-old adolescent is presented. He was admitted suffering from neck pain for more than 3 years.

METHOD

Plain X-rays, technetium bone scanning, CT scan and MRI indicated an expansile, partially sclerotic lesion of the C3 involving the superior facet and pedicle on the right side. The lesion was excised through a posterior approach.

RESULT

Even though the 18-month follow-up is still a very short interval in our case, the subject's neck pain has resolved completely and there has been no sign of tumor recurrence in the recently taken imaging. There has been no clinical or radiologic sign of instability in the follow-up investigations. To the best of our knowledge, this is the third case of C3 osteoblastoma reported in the literature, highlighting the predilection of the reported cases to occur in 14- to 16-year-old boys.

CONCLUSION

A full investigation is indicated in youngsters suffering from persisting neck pain and complete resection of the lesion can prevent recurrence and malignant transformation. Long-term follow-up is needed to declare a lifelong cure of the disease.

[Cervical spine osteoblastoma in children: Selective diagnostics as the basis for effective surgical management]

Expansively growing cervical spine osteoblastomas are rare but can cause severe neurological damage as a result of their anatomical relationship to nerve structures. Also, cerebral vessels, especially the vertebral artery in its transvertebral position, are often covered by tumor tissue. In complete resection of the tumor, it is sometimes possible to retain the affected vessel. In addition to conventional radiographic diagnostics, computed tomography, and magnetic resonance imaging, angiography and Doppler sonography of the intracranial arteries executed in parallel can provide evidence of the dimension of the neurological deficit to be expected during resection. This case report describes the staged diagnostic procedure and successful complete resection, retaining the affected vertebral artery, of an osteoblastoma of the 5th cervical body with massive intraspinal expansion in an 11-year-old child.

Severe neck and back pain in adolescence: remember osteoblastoma

Osteoblastoma is a rare benign tumor of the bone. A 15-year-old boy presented with severe neck and back pain and was followed up for myofascial pain syndrome for 12 months. There was no neurologic deficit or scoliosis. The X-ray of the patient was normal. MRI revealed local destructive tumorous lesion of the T3-T5 vertebrae. The tumor was resected by a spinal surgeon and histologic examination revealed osteoblastoma. The patient's complaints have been completely resolved and there was no recurrence during the follow-up.

Spinal osteoblastoma complicated with epidural hematoma: two case reports

STUDY DESIGN

Case report.

OBJECTIVE

To describe 2 patients of spinal osteoblastoma in upper thoracic lamina, complicated with epidural hematoma and symptoms of cord compression.

SUMMARY OF BACKGROUND DATA

Review the clinical presentation, radiologic findings, and treatment in these 2 cases, with an emphasis on surgical management and outcomes.

METHODS

Two patients initially presented with symptoms of incomplete neurological deficit after mild injury. Computer tomography scan indicated osteolytic destruction of thoracic lamina; magnetic resonance imaging illustrated that lesion in the posterior element of thoracic spine with epidural hematoma and sign of spinal cord compression. Marginal surgical resection and hematoma evacuation were performed.

RESULTS

Histologic diagnosis indicated destructive osteoblastomas with hemorrhage. Complete neurologic recovery was achieved at 1 week and 3 months after surgery. Both patients had no evidence of tumor recurrence at an average follow-up of 37 months.

CONCLUSION

By using surgical resection and hematoma evacuation, good outcome could be achieved for spinal osteoblastoma complicated with epidural hematoma.