Osteoblastoma crossing the sacro-iliac joint

Osteoblastoma of the sacrum: report of 18 cases and analysis of the literature

STUDY DESIGN

Retrospective case series.

OBJECTIVE

(1) To analyze clinical and radiographical characteristics, treatment, and outcome in patients with sacral osteoblastoma, (2) to evaluate progression-free survival and local recurrence rate, and (3) to identify prognostic factors.

SUMMARY OF BACKGROUND DATA

Osteoblastoma is a rare tumor that has been reported to affect the sacrum from 7% to 17%. Symptoms are various and the diagnosis is often delayed.

METHODS

From 1980 to 2010, 18 patients with sacral osteoblastoma (16 males and 2 females) were treated at Rizzoli Institute. Lesion involved S1 (2 cases), S1-S2 (3 cases), S2 (1 case), S2-S3 (1 case), S2-S4 (1 case), S3 (2 cases), S3-S4 (5 cases), S4 (1 case), and almost the entire sacrum in 2 cases. According to Enneking classification for benign bone tumors, 13 (72%) were diagnosed at stage 2 and 5 (28%) at stage 3. Mean tumor volume was 64 cm (range, 2-441 cm). Nine patients had preoperative magnetic resonance imaging. Five patients had a previous inadequate intralesional surgery elsewhere. Treatment consisted in intralesional surgery (16 cases), intralesional surgery and radiotherapy (1 case), and wide resection (1 case). Local adjuvants used were phenol (7 patients), cryocoagulation with "iceball" technique (1 case). Embolizations were performed in 7 patients.

RESULTS

At a mean of 8.4 years (range, 1-28 yr), 15 patients (83%) remained continuously disease free, whereas 3 patients had local recurrence (17%). Progression-free survival was 87% at 5 years and 74% at 10 years. No statistical difference was found between patients who received or not local adjuvants (P = 1.254), older or younger than 20 years (P = 0.970), at stage 2 or 3 (P = 0.826), evaluated preoperatively with or without magnetic resonance imaging (P = 0.160), primarily treated versus patients with previous intralesional surgery elsewhere (P = 0.131).

CONCLUSION

In our series, curettage was successful in most of the patients. Local adjuvants did not seem to reduce the risk of local recurrence when combined with intralesional surgery.

LEVEL OF EVIDENCE

4.

Imaging of sarcomas of pelvic bones

Sarcomas are the most common nonhematologic primary malignancies of bones in the pelvis. Chondrosarcoma, osteosarcoma, and Ewing's sarcoma are the most common sarcomas to originate from the pelvic bones. Various imaging modalities such as magnetic resonance imaging and computed tomography play an important role in the detection, characterization, and staging of these lesions. Biopsy, usually performed with imaging guidance, is essential for the histologic diagnosis of these tumors and for planning therapeutic options. Despite considerable advances in treatment options, sarcomas in the pelvic bones generally are associated with poorer outcomes than sarcomas in the appendicular skeleton because of the larger size of the lesions at the time of discovery and the difficulty of obtaining a wide surgical resection margin. In this review, we discuss the various types of pelvic bone sarcomas and the role of imaging in patients with these lesions.

Low level laser therapy (LLLT) for patients with sacroiliac joint pain

BACKGROUND AND AIMS

Sacroiliac joint pain not associated with a major etiological factor is a common problem seen in the orthopedic clinical setting, but diagnosis is difficult because of the anatomical area and thus it is sometimes difficult to effect a complete cure. Low level laser therapy (LLLT) has been well-reported as having efficacy in difficult pain types, so the following preliminary study was designed to assess the efficacy of LLLT for sacroiliac pain.

MATERIALS AND METHODS

Nine patients participated, 4 males and 5 females, average age of 50.4 yrs, who attended the outpatient department with sacroiliac pain. The usual major disorders were ruled out. Pain was assessed subjectively pre-and post-LLLT on a visual analog scale, and trunk range of motion was examined with the flexion test to obtain the pre- and post-treatment finger to floor distance (FFD). The LLLT system used was an 830 nm CW diode laser, 1000 mW, 30 sec/point (20 J/cm(2)) applied on the bilateral tender points twice/week for 5 weeks. Baseline and final assessment values (after the final treatment session) were compared with the Wilcoxon signed rank test (nonparametric score).

RESULTS

All patients completed the study. Eight of the 9 patients showed significant pain improvement and 6 demonstrated significantly increased trunk mobility (P <0.05 for both).

CONCLUSIONS

LLLT was effective for sacroiliac pain, and this may be due to improvement of the blood circulation of the strong ligaments which support the sacroiliac joint, activation of the descending inhibitory pathway, and the additional removal of irregularities of the sacroiliac joint articular surfaces. Further larger-scale studies are warranted.

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.