Balancing spinal stability and future mobility in the cervical spine: surgical treatment of a case of osteoblastoma with secondary aneurysmal bone cyst

Aneurysmal bone cyst and osteoblastoma: an extremely rare combination in the pediatric spine

STUDY DESIGN

Case report.

OBJECTIVE

To report the clinical and imaging findings of a patient with the extremely rare association of aneurysmal bone cyst and osteoblastoma in the cervical spine. To our knowledge, only three cases have been reported in the published literature in children under 16 years of age with this condition in the cervical spine.

METHODS

The patient's history, physical examination, imaging findings, and management with a complete 4-year medical history, surgical intervention and radiological follow-up are reported.

RESULTS

A 4-year 11-month-old boy was diagnosed with aneurysmal bone cyst in association of osteoblastoma and was treated with CT-guided intralesional injection calcitonin and methylprednisolone. During the course of intralesional therapy, a pathological fracture of C2 was produced. Subsequently, a widened intralesional excision and instrumented fusion from occiput to cervical spine (C0-C4) was performed.

CONCLUSION

The association of aneurysmal bone cyst and osteoblastoma in spine is extremely rare. Although both are benign lesions, in the cervical location, complete removal of the tumors is challenging. Wide resection with reconstruction of the segments for stability associated with adjuvant treatment with calcitonin and corticosteroids provides a good option.

C4 cervical spine osteoblastoma associated with secondary aneurysmal bone cyst in an adolescent patient: 2-year follow-up

Introduction

Osteoblastoma and aneurysmal bone cyst (ABC) are rare bone tumors with individual prevalence of <1%. Their combined occurrence is a rare subclass of tumors in the spinal column with only a few cases reported in literature.

Case presentation

The present case is a rare combination of aggressive osteoblastoma with secondary aneurysmal bone cyst masquerading as neck pain, arising from cervical C4 vertebra in a 19-year-old male. The patient presented with complaints of neck pain for 7 months, gradual in onset, dull, aching, and progressively increasing in severity. Neurological examination was normal. Radiology showed an expansile lytic mass arising from the posterior elements of C4 vertebra involving the left lateral mass. Piecemeal total removal was done and a posterior fusion from C3 to C5 was performed for stability. Histopathology confirmed the osteoblastoma with a secondary aneurysmal bone cyst. Postoperatively the patient recovered well, and no recurrence was seen on a 2-year follow-up.

Discussion

Simultaneous presence of an osteoblastoma with a secondary ABC arising from various bones, such as cranial fossa, ethmoid sinus, skull, and mandibular condyle, has rarely been reported. It is often diagnosed late due to nonspecific symptoms; but it has a good prognosis if early and complete resection is performed. Thorough surgical excision is always a challenge in spine cases due to surrounding important structures and meticulousness is required to prevent any recurrences. Hence, we recommend a surgical team comprising both spine and musculoskeletal oncologic surgeons to achieve best results.

Management Strategy of Osteoblastomas Localized in the Occipitocervical Junction

OBJECTIVE

The aim of this article was to analyze extracted patient data from the literature and highlight the best treatment options and survival outcomes for osteoblastomas in the occipitocervical region.

METHODS

A systematic literature search method was used to select articles containing information about the demographic features, tumor location, treatment characteristics, adjuvant therapies, and follow-up time.

RESULTS

From 25 articles, 31 cases of osteoblastoma in the occipitocervical junction were selected for analysis. Average patient age was 17 years (range, 5-57 years); there were 21 male (67%) and 10 female (33%) patients. All patients had cervical pain as the presenting symptom. Other symptoms included torticollis (0.13%) and sensory or motor neurologic deficits (0.16%). The average follow-up time was 41 months, and the local recurrence rate was 0.125%. Recommendations of each article are categorized and discussed in detail.

CONCLUSIONS

Osteoblastoma is a rare entity in the occipitocervical region, so treatment experiences are limited and mostly based on case reports. To determine the best treatment for these lesions, osteoblastomas should be staged using the Enneking staging system; different methods may be recommended for different stages, and the feasibility of fusion depends on the remaining amount of bony structures and joints. Additional adjuvant therapies may be recommended only in special cases.

A rare case of osteoblastoma associated to aneurysmal bone cyst of the spine. Case report

Osteoblastoma is a rare bone tumour. It is occasionally associated with an aneurysmal bone cyst (ABC). Several treatment strategies can be adopted. We report a challenging case of an osteoblastoma associated with ABC of the lumbar spine in a 2-year-old boy. The pathogenesis and the critical management of the disease are discussed.

Aneurysmal bone cyst involving the c2 vertebra

A 9-year-old boy presented with a 3-month history of cervical pain, limited range of motion, and a palpable "bump" in his posterior neck. After treatment with antibiotics for presumptive adenopathy and progression of the palpable finding, radiographs were obtained.

Aneurysmal bone cyst presenting as a pathologic fracture in a 12-year-old football player

OBJECTIVE

The purpose of this report is to describe a case of an aneurysmal bone cyst presenting as a pathologic fracture in a young athlete.

CASE REPORT

A 12-year-old patient presented to a chiropractic teaching clinic with a 1-week history of posterior neck pain and stiffness following a helmet-to-helmet collision in football practice. Cervical spine radiographs were taken. Lateral view radiograph demonstrated a pathologic fracture through a lytic, expansive lesion in the posterior arch of C7 with mild subluxation of the C7/T1 apophyseal joints and angulation of the C7/T1 disk space. Based upon these findings, additional diagnostic imaging was ordered. Findings on advanced imaging studies included the following: On computed tomography, the C7 lesion showed medullary destruction, cortical thinning and expansion, and a horizontally oriented fracture through the spinous and lamina. Magnetic resonance imaging studies for sagittal T2 and contrast-enhanced T1-weighted magnetic resonance images revealed fluid/fluid levels in the C7 spinous and peripheral enhancement with contrast.

OUTCOME

The patient was referred to a local hospital for treatment. The lesion was treated with resection of the posterior arch, and an aneurysmal bone cyst was confirmed histologically. The patient developed a kyphotic deformity at the site of resection and cervical instability. A subsequent fusion was performed.

CONCLUSION

Aneurysmal bone cysts are rare lesions. In this case, the initial traumatic history masked the underlying pathology. Although rare, pathologic fracture should be considered in cases of vertebral fracture in young patients.

Clinical features and surgical management of spinal osteoblastoma: a retrospective study in 18 cases

OBJECTIVES

To investigate the clinical manifestation and surgical outcome of spinal osteoblastoma.

METHODS

From June 2006 to July 2011, 18 patients with spinal osteoblastoma treated surgically were analyzed retrospectively. There were 11 males and 7 females with an average age of 27.5 years（range, 16-38 years). The tumors were located at C5 in 7, C6 in 6, C7 in 3, C6-T1 1 in 1 and T11 in 1. Based on WBB classification, 16 were 1-3 or 10-12 and 2 were 4-9 and 1-3. 18 operations had been performed with en bloc resection. A posterior approach was used for 16 patients, and a combined posterior and anterior approach was used for 2 patients. Reconstruction using instrumentation and fusion was performed using spinal instrumentation in 13 patients. We used visual analogue scales (VAS) to evaluate the change of pain before and after the operation, and the McCormick System to assess functional status of the spine. Imaging test was used to review the stability and recurrence rate of spine cord, and the confluence of graft bones.

RESULTS

All cases were followed up for 24-80 months (average, 38.4 months). The average surgical time was 120.8 minutes (range, 80-220 minutes), with the average intraoperative blood loss of 520 ml (range, 300-1200 ml). During the follow-up period, the VAS grade reduced from 6.46±1.32 to 2.26±1.05 (P <0.05). 15 patients had neurological function improved and 3 remained no change which was evaluated by McCormick scale for spinal function status at final follow-up.

CONCLUSIONS

Spinal osteoblastoma has its own specific radiographic features. There is some recurrence in simple curettage of tumor lesion. The thoroughly en bloc resection of tumor or spondylectomy, bone fusion and strong in Ter fixation are the key points for successful surgical treatment.

Solid variant of aneurysmal bone cyst on the cervical spine of a child: case report, differential diagnosis and treatment rationale

INTRODUCTION

Despite numerous descriptive publications, the nature, character, differential diagnosis and optimal treatment of aneurysmal bone cysts (ABCs), remain obscure. The authors report a case of the solid variant of aneurysmal bone cyst (S-ABC) occurring in the posterior components and body of C7 vertebra focusing on the differential diagnosis and surgical treatment rationale.

CASE REPORT

Right shoulder and neck pain were the presenting symptoms of 9-year-old boy. Torticollis developed later on but no neurological deficit was found. Imaging revealed an osteolytic lesion with significant extraosseous extension. Although diagnosis favoured an ABC, imaging studies did not provide clear diagnostic criteria. CT guided biopsy performed preoperatively was also not directly diagnostic. Given that differential diagnoses included S-ABC but also giant cell tumor (GCT) of bone, decision was made to proceed with a staged, back and front, complete resection of the affected bony elements of C7. Preoperative spinal angiography showed supply to the tumor from the right ascending and deep cervical artery territories. Particle embolization was not performed due to the presence of ipsilateral supply to the anterior spinal artery at the C6 level and contralateral supply at the C7 level. Intraoperatively, histology taken from posterior elements, although again not clearly diagnostic, favoured S-ABC variant rather than GCT. Thus, initial plan was revised and anterior surgery was postponed as the extent of the dissection would have been dependent on the presumed diagnosis. The final histological report confirmed the diagnosis of an S-ABC. In view of this, it was decided to embolize the lesion to avoid a second stage anterior surgery. At embolization, repeat spinal angiography showed reduced tumor blush following the surgery. Distal branches of the deep cervical artery were occluded with platinum coils (avoiding the risks associated with the use of particles or liquid embolic agents). No further procedure was planned.

CONCLUSION

Imaging and histological pattern of this specific type of ABC, differential diagnosis from GCT and the surgical protocol followed with the patient consist of an interesting case of revising the initial plan, according to the upcoming histological reports.