Treatment of osteoblastoma at C7: a multidisciplinary approach. A case report and review of the literature

Abstract

Osteoblastoma is a rare benign bone tumor that presents with back pain and occurs in the spine approximately 40% of the time. The time from onset of symptoms to diagnosis is typically several months because it is a rare entity and radiographic studies are often negative early in the course of the disease. These highly vascular and locally aggressive tumors require complete and precise resection. The patient presented is a 15-year-old boy with a 14-month history of right-sided neck and shoulder pain. Computerized tomography and magnetic resonance imaging demonstrated a lesion in the posterior elements of C7 which extended through the pedicle and into the body. Preoperative angiography confirmed a hypervascular lesion which was successfully embolized. He subsequently underwent piecemeal tumor resection and instrumented fusion. Immediate postoperative imaging demonstrated complete resection. At 18 months follow up the patient has maintained resolution of preoperative symptoms and demonstrates evidence of solid fusion on CT. This multidisciplinary approach markedly decreased blood loss and improved visualization to help achieve complete surgical resection and resolution of clinical symptoms.

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

“…Since the osteoblastoma is a Fig. 6 CT scan performed shortly after surgery demonstrates the complete removal of the tumor hypervascularized tumor, preoperative embolization has been suggested as a tool to decrease intraoperative blood loss, reduce the incidence of tumor recurrence, and facilitate the total resection of the tumor mass [3,9,18]. However, this strategy has not been adopted universally regardless of the lesion's vascularity [13].…”

“…Most of these lesions arise within the posterior elements of the spine. Vertebral body involvement rarely occurs alone but may be involved via tumor extension through the pedicle [3,5,6]. The vertebral body may be more commonly affected in the cervical spine.…”

“…4 The performed intraoperative CT scan shows a tiny remnant of the tumor, lying just anteriorly to the vertebral artery tumors [5]. Since in osteoblastoma pain is often accompanied by bone destruction and a bigger tumoral mass, the appearance of painful scoliosis or torticollis is more common [14] and the incidence of accompanying neurological deficits is higher [3,7,15]. Imaging modalities used to diagnose osteoid osteoma and osteoblastoma are primarily CT and MRI.…”

“…Additional studies include plain X-ray and bone scan. Plain X-rays are more useful in the detection of osteoblastomas, but may miss small neoplasms [3,8,10,11]. CT scan will delineate the location and osseous involvement of the mass and MRI will provide appreciation of the effect on soft tissues and neural elements [12,16] but sometimes MRI images may over-diagnose the limits of the tumor [9].…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the “surgical and research” articles in the European Spine Journal, 2010

“…However, those that not only give the case report, but also carry out a review of the literature are of interest and of value. I particularly enjoyed the paper dealing with treatment of a cervical osteoblastoma [43], and the report dealing with iatrogenic injury of the thoracic aorta by an implant [21]. Both had excellent literature discussions.…”