Benign osteoblastoma of the spine in childhood

Osteoblastoma of the spine is a rare but important cause of back pain in children. Ten children with this tumor were treated at the Alberta Children's or Foothills Hospital in Calgary, Alberta, between 1974 and 1986. There were seven boys and three girls; the age at diagnosis ranged from 2 to 16 years (average 11 years). In nine patients the tumor involved the posterior vertebral elements. One of the cervical lesions was in the vertebral body. Three patients had tumor in the extradural space. The commonest symptom was pain in the back and neck. Bone scans were positive in all patients, and computerized tomography scans were abnormal in the eight patients who had this imaging performed. Nine children were treated with laminectomy and removal of the abnormal pedicle and facet. Two patients required two operations each because of incomplete tumor excision at the first operation; in these, subsequent surgery gave complete relief of symptoms and radiographic studies showed no further tumor. In three other patients, tumor removal was incomplete, and one patient received postoperative radiation therapy. Bone grafts were placed in four patients. The diagnosis of benign osteoblastoma was confirmed histologically in nine patients. The outcome was good in all cases, with excellent pain relief. The follow-up period has varied from 8 to 153 months (average 66 months) and there have been no recurrences. Based on this experience, complete excision of spinal osteoblastomas is recommended whenever possible. However, a satisfactory outcome may be achieved following incomplete excision and bone grafting.