Surgical treatment options for aggressive osteoblastoma in the mobile spine

Osteoblastoma (OBL) is a benign bone tumor with considerable recurrence potential. Resection is the mainstay for the treatment of Enneking stage 3 (st. 3) OBL. This retrospective study aimed to verify the appropriate surgical strategy for st. 3 lesions in the mobile spine. 19 cases of st. 3 OBL was diagnosed between 2001 and 2011. Clinical, radiological, surgical, and follow-up data were analyzed. This series included 14 men and 5 women and the mean age at diagnosis was 30.4 years. The lesions were located in the cervical spine in ten cases, in the thoracic spine in eight, and in the lumbar spine in one. Fourteen patients were surgically treated for the first time (intact cases), and five were referred to us after previous unsuccessful treatments (non-intact cases). Before 2008, 11 patients underwent curettage followed by radiotherapy, including 5 non-intact cases and 6 intact cases. Tumor recurrence was observed in all five non-intact cases and four of the six intact cases. After 2008, eight intact patients underwent intralesional vertebrectomy, including six who underwent piecemeal total vertebrectomy and two who underwent intralesional en bloc vertebrectomy. All the eight patients had embolization before surgery. 18 patients had an average 67.3 months (range 36–148 months) of follow-up. Recurrence was not observed in any of these eight cases with intralesional vertebrectomy. Intralesional total vertebrectomy might be an appropriate choice for intact st. 3 OBL spine lesions. More cases with longer follow-up periods should be recruited in the future to better understand the treatment options available for this disease.