Surgical management of cervical spine osteoblastomas

The treatment of cervical spine osteoblastomas requires complex therapeutic and reconstructive strategies depending on the tumor's location, local aggressiveness, and proximity to the surrounding neurovascular structures. Despite careful removal, lesions recur in as much as 10% of patients. Preoperative embolization is useful to minimize intraoperative bleeding and decrease the relapse of vascular tumors, but its role in osteoblastoma surgery is yet to be defined. We asked whether preoperative embolization with marginal resection would lead to osteoblastoma recurrence, and whether marginal excision with reconstruction would improve neurologic symptoms. We retrospectively analyzed a consecutive series of patients with cervical spine osteoblastoma, treated by one surgeon with a combined approach of preoperative embolization, marginal excision, and spinal reconstruction. One of nine patients presented with a monoradiculopathy, whereas only two patients presented with symptomatic spinal cord compression. At followup, all patients showed neurologic improvement, no tumor relapse, and adequate bony healing. Followup imaging studies showed cervical alignment was maintained. Although we report only a small uncontrolled cohort, the data suggest preoperative embolization and a tumor-free margin are consistent with a prolonged disease-free interval or complete tumor eradication.