Szathmari Alexandru, Almeida Laryssa Crystinne Azevedo, Beuriat Pierre-Aurélien, de Laurentis Camilla, Vinchon Matthieu, Di Rocco Federico
Departement of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Lyon, France.
University of Medicine, Université Claude, Bernard 1, Lyon, France.
Childs Nerv Syst. 2024 Dec 27;41(1):69. doi: 10.1007/s00381-024-06732-x.
Osteoid osteoma (Oo) and osteoblastoma (Ob) are rare primary bone tumors with a higher prevalence in the second decade of life. Treatment can be conservative, but in cases of spinal location, resective surgery is of great importance but may be challenging.
We report four pediatric cases of Oo and Ob managed in our unit, with different locations at the level of the cervical spine. All four patients had a common complaint of persistent and progressive neck pain, two reported worsening pain at night, and three underwent NSAID treatment attempts without significant response. The radiological examination revealed a lesion of bone origin in the cervical spine in all cases: two at the pediculolaminar complex, one at the laminar, and one at the level of the C2 body and odontoid. A comprehensive literature review was carried out by comparing the data and a discussion of the cases.
A complete surgical resection was performed by a posterior approach in three patients and a transoral in one. A hard neck collar under molding ensured postoperative stability in all cases. Control imaging studies demonstrated satisfactory lesion resection. Histologically, three cases were an osteoblastoma and one an osteoid osteoma. Control imaging studies demonstrated satisfactory lesion resection with good late bone reconstruction. Ultimately, none showed late instability requiring fixation. The mean follow-up time is 36 (16-63) months. None had a recurrence nor late instability requiring fixation.
Treatment of pediatric cervical spine of osteoid osteoma and osteoblastoma should seek a complete resection. In regions with a risk for secondary instability, the preservation of capsule-ligamental structures and temporary orthopedic immobilization can allow bone regeneration with no need for fixation. Extended follow-up is recommended especially in very young children to avoid late instability.
骨样骨瘤（Oo）和成骨细胞瘤（Ob）是罕见的原发性骨肿瘤，在生命的第二个十年发病率较高。治疗可以是保守的，但在脊柱部位的病例中，切除手术非常重要，但可能具有挑战性。
我们报告了在我们科室治疗的4例小儿骨样骨瘤和成骨细胞瘤病例，病变位于颈椎不同节段。所有4例患者都有持续且进行性颈部疼痛的共同主诉，2例报告夜间疼痛加重，3例尝试使用非甾体抗炎药治疗但无明显效果。影像学检查显示所有病例颈椎均有骨源性病变：2例位于椎弓根-椎板复合体，1例位于椎板，1例位于C2椎体和齿状突水平。通过比较数据进行了全面的文献综述并对病例进行了讨论。
3例患者采用后路手术完全切除，1例采用经口手术。定制的硬颈托确保了所有病例术后的稳定性。对照影像学研究显示病变切除满意。组织学检查显示，3例为成骨细胞瘤，1例为骨样骨瘤。对照影像学研究显示病变切除满意，后期骨重建良好。最终，无一例出现需要固定的后期不稳定情况。平均随访时间为36（16 - 63）个月。无一例复发或出现需要固定的后期不稳定情况。
小儿颈椎骨样骨瘤和成骨细胞瘤的治疗应寻求完全切除。在有继发性不稳定风险的区域，保留囊-韧带结构并进行临时矫形固定可实现骨再生而无需固定。建议进行长期随访，尤其是对非常年幼的儿童，以避免后期不稳定。
