Aggressive "benign" primary spine neoplasms: osteoblastoma, aneurysmal bone cyst, and giant cell tumor

Clinically based systematic review.

To define optimal clinical care for primary spinal aggressive "benign" osseous neoplasms using a systematic review with expert opinion.

Predefined focused questions on treatment of osteoblastomas, aneurysmal bone cysts and giant cell tumors were refined by a panel of spine oncology surgeons, medical and radiation oncologist. Keywords were searched through Medline and pertinent abstracts and articles obtained. The quality of literature was rated as high, moderate, low or very low. Based on literature review and expert opinion recommendations were composed through the GRADE system and rated as either strong or weak.

The literature searches revealed very low quality evidence with no prospective or randomized studies. There are a limited number of patients with aggressive primary osseous tumors. The osteoblastoma initial search identified 211 articles of which 17 were pertinent to the spinal questions. The aneurysmal bone cysts initial search revealed 482 articles initially of which 6 were pertinent; and the search on giant cell tumors identified 178 articles of which only 8 were focused on the predefined treatment questions.

Spinal aggressive benign osseous neoplasms have varying histology. Despite these differences surgical treatment should be directed at gross resection of the tumor, understanding that this may be limited by anatomic confines and the potential for morbidity.