Keywords
osteoblastoma - neck pain - embolization - spinal cord neoplasms
Introduction
Osteoblastoma is a rare and benign primary bone tumor that account for 3% of benign
and 1% of all primary bone tumors.[1]
[2] Approximately 32–46% involve the spine.[2]
[3] These lesions occur predominately in second and third decade of life and in male
with a 2:1 male to female ratio.[3]
[4] Pain is the most commonly cited symptom and often present for greater than a year
prior to diagnosis.[1]
[2]
[3]
[4] Late diagnosis of these lesions relates to its low incidence, non-specific symptoms
and normal radiological study during the initial course of disease.[3]
[4] The treatment goal is complete surgical resection which allows the complete regression
of complaints and decrease the likelihood of relapse.[2]
[5]
Discussion
Osteoblastoma and osteoid osteoma were described in 1935 by Jaffe apud Samdani et
al.[3] They are both hypervascular tumors benign clinically and histologically similar.[3]
[6] However, osteoblastoma demonstrates more aggressive characteristics. It can be locally
aggressive and cause neurologic impairment due the expansible growth. Furthermore,
it can undergo malignant transformation to osteosarcoma.[2]
[3]
[6]
In spine osteoblastoma usually involves the posterior elements.[2]
[4]
[6] Although it is considered a benign tumor, spinal lesions recurrence is not uncommon
and have been reported in 9.7–15% of series of spinal osteoblastomas.[6]
The most common presentation is neck pain[1]
[4]
[6] and it is not relieved by nonsteroidal anti-inflammatory drugs.[5] Other common signs and symptoms include torcicollis, stiffness and local tenderness.[4]
The diagnosis is usually made by CT scan.[5] It will delineate the location and osseous involvement of the mass.[3]
Surgical excision is the treatment of choice for osteoblastoma.[1]
[2]
[5]
[7] This treatment limits the risk of recurrence.[5] The main reason for high rate of recurrence is incomplete resections.[6]
[7] Careful pre-operative planning is essentiall.[7]
Because osteoblastoma is a high vascular tumor, complete resections is often impeded
by extensive intraoperative bleeding.[2] Some authors recommend pre-operative embolization. It has been described since 1979
by Dick et al. and apud Samdani et al.[3] as an adjunctive therapy for benign bone tumors. More recently, it has been success-
fully applied to highly vascular spinal tumors.[3] It reduces intraoperative bleeding, and help to enhance visualization to perform
a complete resection. It also reduces post-operative complications.[2]
[3]
The authors report a well-succeeded case of C7 osteoblastoma. In the current case,
the authors preferred a two stage approach. The posterior approach allowed tumor resection.
The anterior approach allowed anterior fusion for spine stabilization, with interbody
cage and instrumentation with anterior plate and screws. We chose anterior arthrodesis
to facilitate imaging follow-up, since it diminishes the imaging artifact in the posterior
elements and that could hinder the interpretation of a possible local recurrence.
We perform a pre-operative embolization that facilitated tumor resection because it
decrease bleeding and improve visualization. The complete resection of this lesion
allowed the complete regression of complaints and decreases the likelihood of recurrence
(without it, the recurrence rate has been reported between 9.8% and 15%).[6]
