title: Long-term outcomes in primary spinal osteochondroma: a multicenter study of 27 patients.
abstract: OBJECT Clinical outcomes in patients with primary spinal osteochondromas are limited to small series and sporadic case reports. The authors present data on the first long-term investigation of spinal osteochondroma cases. METHODS An international, multicenter ambispective study on primary spinal osteochondroma was performed. Patients were included if they were diagnosed with an osteochondroma of the spine and received surgical treatment between October 1996 and June 2012 with at least 1 follow-up. Perioperative prognostic variables, including patient age, tumor size, spinal level, and resection, were analyzed in reference to long-term local recurrence and survival. Tumor resections were compared using Enneking appropriate (EA) or Enneking inappropriate surgical margins. RESULTS Osteochondromas were diagnosed in 27 patients at an average age of 37 years. Twenty-two lesions were found in the mobile spine (cervical, thoracic, or lumbar) and 5 in the fixed spine (sacrum). Twenty-three cases (88%) were benign tumors (Enneking tumor Stages 1-3), whereas 3 (12%) exhibited malignant changes (Enneking tumor Stages IA-IIB). Sixteen patients (62%) underwent en bloc treatment-that is, wide or marginal resection-and 10 (38%) underwent intralesional resection. Twenty-four operations (92%) followed EA margins. No one received adjuvant therapy. Two patients (8%) experienced recurrences: one in the fixed spine and one in the mobile spine. Both recurrences occurred in latent Stage 1 tumors following en bloc resection. No osteochondroma-related deaths were observed. CONCLUSIONS In the present study, most patients underwent en bloc resection and were treated as EA cases. Both recurrences occurred in the Stage 1 tumor cohort. Therefore, although benign in character, osteochondromas still require careful management and thorough follow-up.
authors: 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
authors: Daniel M
authors: DM
authors: Sciubba
authors: 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
authors: Mohamed
authors: M
authors: Macki
authors: 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
authors: Mohamad
authors: M
authors: Bydon
authors: 2Research Department, AOSpine International, Davos, Switzerland;
authors: Niccole M
authors: NM
authors: Germscheid
authors: 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
authors: Jean-Paul
authors: JP
authors: Wolinsky
authors: 3Department of Degenerative and Oncological Spine Surgery, Rizzoli Institute, Bologna, Italy;
authors: Stefano
authors: S
authors: Boriani
authors: 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
authors: Chetan
authors: C
authors: Bettegowda
authors: 4Department of Neurological Surgery, University of California, San Francisco, California;
authors: Dean
authors: D
authors: Chou
authors: 5Oncologia Ortopedica e Ricostruttiva del Rachide, Istituto Ortopedico Galeazzi, Milano, Italy;
authors: Alessandro
authors: A
authors: Luzzati
authors: 6Spinal Division, Oxford University Hospital NHS Trust, Oxford, United Kingdom;
authors: Jeremy J
authors: JJ
authors: Reynolds
authors: 7National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary;
authors: Zsolt
authors: Z
authors: Szövérfi
authors: 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
authors: Patti
authors: P
authors: Zadnik
authors: 8Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas; and.
authors: Laurence D
authors: LD
authors: Rhines
authors: 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
authors: Ziya L
authors: ZL
authors: Gokaslan
authors: 9Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver Coastal Health, Vancouver, BC, Canada.
authors: Charles G
authors: CG
authors: Fisher
authors: 7National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary;
authors: Peter Paul
authors: PP
authors: Varga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D015831:Osteochondroma / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000601:surgery*; D013995:Time; D016896:Treatment Outcome; D055815:Young Adult
keywords: EA = Enneking appropriate; EC = Enneking classification; EI = Enneking inappropriate; HME = hereditary multiple osteochondroma/exostosis; neoplasm; oncology; osteochondroma; spine; tumor