title: Aggressive "benign" primary spine neoplasms: osteoblastoma, aneurysmal bone cyst, and giant cell tumor.
abstract: METHODS
  Clinically based systematic review.
  
  
  OBJECTIVE
  To define optimal clinical care for primary spinal aggressive "benign" osseous neoplasms using a systematic review with expert opinion.
  
  
  METHODS
  Predefined focused questions on treatment of osteoblastomas, aneurysmal bone cysts and giant cell tumors were refined by a panel of spine oncology surgeons, medical and radiation oncologist. Keywords were searched through Medline and pertinent abstracts and articles obtained. The quality of literature was rated as high, moderate, low or very low. Based on literature review and expert opinion recommendations were composed through the GRADE system and rated as either strong or weak.
  
  
  RESULTS
  The literature searches revealed very low quality evidence with no prospective or randomized studies. There are a limited number of patients with aggressive primary osseous tumors. The osteoblastoma initial search identified 211 articles of which 17 were pertinent to the spinal questions. The aneurysmal bone cysts initial search revealed 482 articles initially of which 6 were pertinent; and the search on giant cell tumors identified 178 articles of which only 8 were focused on the predefined treatment questions.
  
  
  CONCLUSIONS
  Spinal aggressive benign osseous neoplasms have varying histology. Despite these differences surgical treatment should be directed at gross resection of the tumor, understanding that this may be limited by anatomic confines and the potential for morbidity.
authors.affiliation: Department of Neurological Surgery and Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. james.harrop@jefferson.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.forename: Meic H
authors.initials: MH
authors.lastname: Schmidt
authors.forename: Stefano
authors.initials: S
authors.lastname: Boriani
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
mesh_terms: D017824:Bone Cysts, Aneurysmal / Q000473:pathology / Q000628:therapy*; D018212:Giant Cell Tumor of Bone / Q000473:pathology / Q000628:therapy*; D006801:Humans; D018215:Osteoblastoma / Q000473:pathology / Q000628:therapy*; D013122:Spinal Diseases / Q000473:pathology / Q000628:therapy*; D013125:Spinal Neoplasms / Q000473:pathology / Q000628:therapy*