Large sacral osteoblastoma: a case report and review of multi-disciplinary management strategies.
BACKGROUND
Osteoblastomas are uncommon primary benign bone tumors. The sacrum is an uncommon site of involvement. We present a case of a large, technically challenging sacral osteoblastoma in a pediatric patient that was managed with en-bloc resection and lumbo-sacral reconstruction showing long-term remission.


METHODS
A 15-year-old Hispanic male presented to our clinic in May 2006 with low back pain. Imaging revealed a large expansile and erosive mass at the S2 vertebral body. Definitive treatment of the lesion with en-bloc surgical resection was planned after a biopsy that confirmed osteoblastoma. The patient underwent pre-operative embolization and a same-day, two-stage resection of the tumor with lumbosacral instrumentation for pelvic reconstruction. The S1 nerve roots were sacrificed during en-bloc resection of the mass. Post-operatively, the patient developed an areflexic bladder without major motor or sensory impairment. Subsequently, insertion of an artificial urinary sphincter and a colostomy were performed. At the five-year follow up, the patient remains symptom free with no detectable recurrence.


CONCLUSIONS
The sacrum is a known, but rare, location for an osteoblastoma. We present a technically challenging case of a pediatric patient with a large sacral osteoblastoma. We highlight the importance of a multidisciplinary approach to ensure a long-term, disease-free outcome.
Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, USA.
Imad Saeed
IS
Khan
Jai Deep
JD
Thakur
Prashant
P
Chittiboina
Anil
A
Nanda
D000293:Adolescent; D001706:Biopsy; D003125:Colostomy; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D018215:Osteoblastoma / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012447:Sacrum / Q000601:surgery; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery*; D016896:Treatment Outcome; D016741:Urinary Sphincter, Artificial