Osteoid osteoma and osteoblastoma of the cervical spine in the pediatric population: analysis of the literature and experience with four operated cases.

Background and aim: 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.

Material and methods: 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.

Results: 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.

Conclusion: 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.