Minimally Invasive Resection of a Pediatric Lumbar Osteoblastoma: Case Report.
Minimally invasive surgery
Osteoblastoma
Spine, Pediatric
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
01 09 2020
01 09 2020
Historique:
received:
11
11
2019
accepted:
19
03
2020
pubmed:
9
6
2020
medline:
28
5
2021
entrez:
8
6
2020
Statut:
ppublish
Résumé
Osteoblastomas are locally aggressive bone tumors typically affecting the posterior elements of the vertebral column. The treatment of choice is total surgical resection, traditionally through an open laminectomy, often with facetectomy and fusion when the lesion is in the foramen. To seek an alternative to open surgery, allowing quick and full functional recovery, to meet the youth and athlete population's specific surgical goals. In this population especially, open surgery can be associated with significant impairment and morbidity. We report a pediatric case of posterior L5 osteoblastoma completely removed using a facet-sparing and fusion-avoiding contralateral foraminal minimally invasive approach using a tubular retractor system. A 12-yr-old male competitive tennis player presented with progressive right L5 lumbosciatica. Computed tomography scan and magnetic resonance imaging revealed a lesion of the right L5 pedicle, facet, and vertebral body with significant foraminal soft-tissue extension. Being unfit for percutaneous radiofrequency ablation, the patient underwent a minimally invasive biopsy and resection using an 18-mm-wide METRx nonexpandable tubular retractor (Medtronic) through a contralateral approach, sparing the facet and avoiding fusion surgery. Postoperative imaging showed residual tumor. The patient was reoperated in a similar fashion with complete tumor removal. His symptoms resolved completely postoperatively. He resumed tennis within 4 mo and remains symptom- and tumor-free at 12-mo follow-up. Minimally invasive contralateral facet-sparing resection of a pediatric lumbar osteoblastoma is an alternative to standard technique and is associated with significant advantages for young athletes, such as quick and full functional recovery, along with avoidance of fusion when the facet joint is involved.
Sections du résumé
BACKGROUND
Osteoblastomas are locally aggressive bone tumors typically affecting the posterior elements of the vertebral column. The treatment of choice is total surgical resection, traditionally through an open laminectomy, often with facetectomy and fusion when the lesion is in the foramen.
OBJECTIVE
To seek an alternative to open surgery, allowing quick and full functional recovery, to meet the youth and athlete population's specific surgical goals. In this population especially, open surgery can be associated with significant impairment and morbidity.
METHODS
We report a pediatric case of posterior L5 osteoblastoma completely removed using a facet-sparing and fusion-avoiding contralateral foraminal minimally invasive approach using a tubular retractor system. A 12-yr-old male competitive tennis player presented with progressive right L5 lumbosciatica. Computed tomography scan and magnetic resonance imaging revealed a lesion of the right L5 pedicle, facet, and vertebral body with significant foraminal soft-tissue extension. Being unfit for percutaneous radiofrequency ablation, the patient underwent a minimally invasive biopsy and resection using an 18-mm-wide METRx nonexpandable tubular retractor (Medtronic) through a contralateral approach, sparing the facet and avoiding fusion surgery.
RESULTS
Postoperative imaging showed residual tumor. The patient was reoperated in a similar fashion with complete tumor removal. His symptoms resolved completely postoperatively. He resumed tennis within 4 mo and remains symptom- and tumor-free at 12-mo follow-up.
CONCLUSION
Minimally invasive contralateral facet-sparing resection of a pediatric lumbar osteoblastoma is an alternative to standard technique and is associated with significant advantages for young athletes, such as quick and full functional recovery, along with avoidance of fusion when the facet joint is involved.
Identifiants
pubmed: 32506134
pii: 5854326
doi: 10.1093/ons/opaa150
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E236-E243Informations de copyright
Copyright © 2020 by the Congress of Neurological Surgeons.