title: Desmoplastic fibroma of the spine: a series of 12 cases and outcomes.
abstract: BACKGROUND
  Desmoplastic fibroma (DF) is a benign, yet locally aggressive, tumor of the connective tissue. Desmoplastic fibroma in the spine is extremely rare, and only a few cases have been reported. Although surgical resection of DF arising in the spine is commonly regarded as a recommended treatment, it is difficult to achieve satisfactory results.
  
  
  OBJECTIVE
  This study reviews the clinical patterns and follow-up data of patients with DF in the spine who underwent surgical treatment. We attempted to correlate surgical treatment and outcomes over time.
  
  
  METHODS
  A retrospective clinical study of the surgical managements, including subtotal resection, total spondylectomy, and en bloc resection, for DF in the spine. Desmoplastic fibroma of the spine treatment occurred from 2004 to 2009 at the Department of Bone Tumor Surgery, AA Hospital.
  
  
  METHODS
  Twelve consecutive cases of DF of the spine underwent surgical treatment at our center between 2004 and 2009.
  
  
  METHODS
  Neurologic outcomes were evaluated using Frankel score system and recurrence and metastasis were evaluated by computed tomography or magnetic resonance imaging of the surgical segments involved. Imaging was performed 3, 6, and 12 months after surgery, every 6 months for the next 2 years, and then annually for life.
  
  
  METHODS
  Overall, two different surgery protocols were applied. One protocol involved subtotal resection followed by radiotherapy (n=4), whereas the other involved total tumor resection (n=8). Postoperative radiotherapy was administered in six cases. Clinical data and surgery efficacy were analyzed via chart review.
  
  
  RESULTS
  Eleven patients were disease-free during their follow-up period, whereas one patient experienced recurrence without metastasis. Radicular pain nearly disappeared, and patients suffering from spinal cord compression recovered well. Local recurrence was detected in one-fourth (25%) of the cases that underwent subtotal resection and was not detected in any of the cases involving total spondylectomy.
  
  
  CONCLUSIONS
  Local recurrence of DF is not uncommon after insufficient removal. Therefore, total excision, while also preserving neural function, is recommended. In our study, patients who underwent a total spondylectomy had significantly lower local recurrence rates for DF in the spine. Radiotherapy may be an acceptable alternative therapy, whereas en bloc resection has the potential to result in significant functional impairment.
authors.affiliation: Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China.
authors.forename: Huabin
authors.initials: H
authors.lastname: Yin
authors.affiliation: Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China.
authors.forename: Zhipeng
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China.
authors.forename: Xinghai
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Jiao
authors.affiliation: Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wan
authors.affiliation: Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Huang
authors.affiliation: Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China.
authors.forename: Wang
authors.initials: W
authors.lastname: Zhou
authors.affiliation: Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China. Electronic address: jianruxiao83@163.com.
authors.forename: Xiao
authors.initials: X
authors.lastname: Jianru
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018220:Fibroma, Desmoplastic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D019637:Orthopedic Procedures / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Case series; Desmoplastic fibroma; En bloc resection; Outcomes; Radiotherapy; Spine; Total spondylectomy