gms | German Medical Science

Objective: Beside the long bones, the spine is the most common localisation for osteoblastomas. They account for about 5% of spinal tumors. It is a benign tumor, however, may grow expansively with local destruction and compression of neural structures. The leading symptoms are resistant local pain, loss of function, and deformity like torticollis or scoliosis. Surgical therapy is usually required. To evaluate the outcome of surgical therapy of this rare entity, the following study was conducted.

Method: From 2003 to 2013, 45 children with surgical therapy of spinal tumors were identified in our databank. Osteoblastoma was histologically verified in 8 patients. One of them was lost for follow-up; seven children were included in the study. Mean age was 11y 9m (7y 8m to 17y 11m). Localisation was most frequent at the cervical spine (4 pat.: C1, C2, C5, C6), one in the thoracic spine (T6), one in the lumbar spine (L3), and one at the sacrum (S1). All patients were treated surgically. Last follow-up with clinical and radiographic examination including CT or MRI was 3y 8m (9m to 7y 8m) postoperatively.

Results: A complete resection of the tumor could be achieved in all cases. The approach was posterior only in 3 cases, combined anterior-posterior in 4 cases (one transoral). Titanium mesh cages for reconstruction were used following corpectomy in 4 patients, and after resection of a lateral mass of C1 in one patient. Average 1.9 (0 to 6) segments were fused. In one case (osteoblastoma in the odontoid) a temporary instrumentation C1/C2 was removed after bony remodelling of the dens to regain atlanto-axial mobility. There was one complication: wound dehiscence at the softpalate requiring secondary suture.

One patient required revision surgery with complete resection of a tumor recurrence 18m after primary surgery. At latest follow-up 5 patients were completely pain free, 2 patients reported occasional slight pain. There were no neurologic deficits. Radiographic examination revealed no tumor reccurence in any case. There was no dislocation of the implants; bony fusion was already evident in 4 cases.

Conclusions: The results of this study suggest that surgical treatment of paediatric spinal osteoblastoma is a safe and efficient procedure. Surgery results in a rapid and continuing pain relief. The surgery should strive for complete resection to avoid local recurrence of the tumor. Stability has to be restored with fusion as short as possible to minimise loss of function.