Long-term outcomes in primary spinal osteochondroma: a multicenter study of 27 patients

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Clinical outcomes in patients with primary spinal osteochondromas are limited to small series and sporadic case reports. The authors present data on the first long-term investigation of spinal osteochondroma cases.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>An international, multicenter ambispective study on primary spinal osteochondroma was performed. Patients were included if they were diagnosed with an osteochondroma of the spine and received surgical treatment between October 1996 and June 2012 with at least 1 follow-up. Perioperative prognostic variables, including patient age, tumor size, spinal level, and resection, were analyzed in reference to long-term local recurrence and survival. Tumor resections were compared using Enneking appropriate (EA) or Enneking inappropriate surgical margins.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Osteochondromas were diagnosed in 27 patients at an average age of 37 years. Twenty-two lesions were found in the mobile spine (cervical, thoracic, or lumbar) and 5 in the fixed spine (sacrum). Twenty-three cases (88%) were benign tumors (Enneking tumor Stages 1–3), whereas 3 (12%) exhibited malignant changes (Enneking tumor Stages IA–IIB). Sixteen patients (62%) underwent en bloc treatment—that is, wide or marginal resection—and 10 (38%) underwent intralesional resection. Twenty-four operations (92%) followed EA margins. No one received adjuvant therapy. Two patients (8%) experienced recurrences: one in the fixed spine and one in the mobile spine. Both recurrences occurred in latent Stage 1 tumors following en bloc resection. No osteochondroma-related deaths were observed.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>In the present study, most patients underwent en bloc resection and were treated as EA cases. Both recurrences occurred in the Stage 1 tumor cohort. Therefore, although benign in character, osteochondromas still require careful management and thorough follow-up.</jats:p></jats:sec>

Risk Factors for Recurrence of Surgically Treated Conventional Spinal Schwannomas

“…In primary spinal tumors, Enneking and Weinstein-Boriani-Biagini (WBB) classifications demonstrated moderate interobserver reliability and substantial to near-perfect intraobserver reliability with respect to staging and treatment decision making, but less than moderate interobserver reliability in interpreting the Enneking local tumor extension and WBB sector. 21 While existing evidence has reported that these classification systems improve disease control and survival in patients with primary spinal bony tumors 22-25 , they are not easily applicable to spinal schwannomas. However, Sridhar et al 26 have proposed a useful classification of spinal schwannomas based on radiological imaging (Table 4 and Figure 1).…”

Hereditary Multiple Exostoses: a review of clinical appearance and metabolic pattern

“…The most are located in the posterior part of the vertebrae, but in 27% of patients MRI can reveal the extension into the spinal canal. Although rare, a symptomatic compression of the medulla can occur with serious neurologic consequences (36). Therefore, spinal osteochondromas require careful management, thorough follow-up and a MRI screening for patients in the growing years in order to prevent serious disability (37).…”

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

“…1,31,37,46,47,52,62,70,72,79,86,95 Risk stratification of patients preoperatively is important to optimize outcomes, 48,52,65,74,86,93,98 and prior studies have identified anatomical location, tumor size, tumor histology, extent of resection, surgical approaches, age, functional status, comorbidities, preoperative medication (steroid use, morphine), longer operative time, insurance status, early postoperative complications, and adjuvant chemotherapy and radiotherapy as factors associated with postoperative morbidity and mortality. 1,[18][19][20][21][22][23][24]39,41,42,44,48,51,52,56,58,66,69,78,92,99 Nevertheless, many of these previous publications were retrospective, institutional studies, 10,11,55,60,65,87,…”

“…1,13,14,16,17,26,27,30,31,38,63,93,[95][96][97][98] However, surgical approaches to spinal tumors often necessitate extensive reconstruction of the spinal column and may require adjuvant chemotherapy or radiation; therefore, perioperative complication rates after spinal tumor surgery are higher than in other spinal operations. [34][35][36][46][47][48]50,52,65,67,68,78,80,81,[86][87][88]95,100 It is especially important to understand the incidence and predictive factors for adverse events in spinal oncology patients, as a single complication may be associated with morbidity, mortality, and costs. 1,31,37,46,47,52,62,70,72,79,86,95 Risk stratification of patients preoperatively is important to optimize outcomes, …”