Sciubba Daniel M, Macki Mohamed, Bydon Mohamad, Germscheid Niccole M, Wolinsky Jean-Paul, Boriani Stefano, Bettegowda Chetan, Chou Dean, Luzzati Alessandro, Reynolds Jeremy J, Szövérfi Zsolt, Zadnik Patti, Rhines Laurence D, Gokaslan Ziya L, Fisher Charles G, Varga Peter Paul
1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
2Research Department, AOSpine International, Davos, Switzerland;
J Neurosurg Spine. 2015 Jun;22(6):582-8. doi: 10.3171/2014.10.SPINE14501. Epub 2015 Mar 20.
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.
原发性脊柱骨软骨瘤患者的临床结局仅限于小样本系列研究和散发病例报告。作者展示了关于脊柱骨软骨瘤病例的首次长期调查数据。方法：开展了一项关于原发性脊柱骨软骨瘤的国际多中心双向研究。纳入在1996年10月至2012年6月期间被诊断为脊柱骨软骨瘤并接受手术治疗且至少有1次随访的患者。参照长期局部复发和生存率分析围手术期预后变量，包括患者年龄、肿瘤大小、脊柱节段和切除情况。使用Enneking合适（EA）或Enneking不合适的手术切缘比较肿瘤切除术。结果：27例患者被诊断为骨软骨瘤，平均年龄37岁。22个病灶位于活动脊柱（颈椎、胸椎或腰椎），5个位于固定脊柱（骶骨）。23例（88%）为良性肿瘤（Enneking肿瘤分期1 - 3期），而3例（12%）出现恶性改变（Enneking肿瘤分期IA - IIB期）。16例患者（62%）接受了整块切除，即广泛或边缘切除，10例（38%）接受了病损内切除。24例手术（92%）遵循EA切缘。无人接受辅助治疗。2例患者（8%）出现复发：1例在固定脊柱，1例在活动脊柱。两次复发均发生在整块切除后的潜伏1期肿瘤。未观察到与骨软骨瘤相关的死亡。结论：在本研究中，大多数患者接受了整块切除并按EA病例处理。两次复发均发生在1期肿瘤队列中。因此，尽管骨软骨瘤本质上是良性的，但仍需要仔细管理和全面随访。
