title: Surgical Management of Osteoblastoma of the Spine: Case Series and Review of the Literature.
abstract: OBJECTIVE
  To describe the demographics, clinical and radiologic presentation, surgical considerations, and clinical outcomes associated with spinal osteoblastoma.
  
  
  METHODS
  A spinal tumor database of 522 patients treated surgically at a single institution between January 2002 and June 2012 was analyzed and five patients with spinal osteoblastoma were identified and included in this study. Basic demographic and epidemiological data were recorded. Tumor characteristics, surgical parameters, and clinical follow-up data were noted.
  
  
  RESULTS
  The mean follow-up was 21.9 months. There were four males and one female, and the mean age at diagnosis was 28.4 years. There was a mean reported symptom length of 26.4 months prior to diagnosis. There were three cervical lesions, one lumbar lesion, and one sacrococcygeal lesion. One patient was Enneking stage III and four patients were Enneking stage II. Based on spinal instability neoplastic score criteria, two patients were stable and three patients were potentially unstable. Four patients had intralesional gross total resections and one patient had an en bloc marginal resection. All patients remained neurologically stable or improved postoperatively. A single patient had recurrence of a previously resected osteoid osteoma with progression to osteoblastoma.
  
  
  CONCLUSIONS
  Aggressive surgical resection of spinal osteoblastoma is suggested to minimize the risk of tumor recurrence, although this may still occur even with en bloc resection. Patients rarely present with preoperative spinal instability, but surgical fusion is often required due to removal of structural elements of the spine during resection. Of note, osteoid osteoma may progress to osteoblastoma in the spine despite prior resection.
authors.affiliation: The Johns Hopkins University School of Medicine, Department of Neurosurgery, Baltimore, Maryland, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Elder
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Kosztowski
authors.forename: Sheng-Fu L
authors.initials: SF
authors.lastname: Lo
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: George I
authors.initials: GI
authors.lastname: Jallo
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D000293:Adolescent; D000328:Adult; D019468:Disease Management; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery; D008161:Lumbosacral Region / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control / Q000601:surgery; D018215:Osteoblastoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*