Abstract:
Benign osseocartilaginous tumors of the spine are overall uncommon, representing between 1 and 13% of all primary bone tumors and less than 10% of all spinal tumors. Tumors in this category include osteoblastic lesions such as the related osteoid osteoma and osteoblastoma, and cartilage-forming lesions including osteochondroma, chondroma, and chondroblastoma. Aneurysmal bone cysts, giant cell tumors of bone, and eosinophilic granulomas also comprise benign tumors of the spine arising from bone. There is significant heterogeneity in the epidemiology, molecular biology, imaging features, and optimal treatment of these lesions. For example, osteoid osteoma is characterized by high expression of the cyclooxygenase enzymes, making it amenable to treatment with anti-inflammatory drugs initially, whereas other lesions such as osteoblastoma may require intralesional curettage or en bloc resection sooner. Generally, en bloc resection is preferred when possible to minimize risk of recurrence. Further, some tumors may arise in the setting of syndromic conditions, such as multiple chondromas arising in Ollier disease or Maffucci syndrome, or as part of genetic disorders, such as osteochondromas in the context of hereditary multiple exostosis. These lesions may present with local pain, cause neurological compromise or be discovered incidentally on routine imaging. The Enneking classification and Weinstein-Boriani-Biagini system are routinely used to classify lesions and assist in surgical planning. More novel techniques such as radiofrequency ablation and laser photocoagulation have been applied for the treatment of osteoid osteoma and may have utility in the treatment of other lesion types. A multidisciplinary approach is critical in the management of benign lesions of the spine, and both chemotherapeutic and surgical approaches are routinely used.
摘要:
脊柱良性骨软骨瘤总体上并不常见,占所有原发性骨肿瘤的1%至13%,占所有脊柱肿瘤的不到10%。这类肿瘤包括成骨细胞病变,如相关的骨样骨瘤和成骨细胞瘤,和软骨形成病变,包括骨软骨瘤,软骨瘤,和软骨母细胞瘤.动脉瘤性骨囊肿,骨巨细胞瘤,嗜酸性肉芽肿也包括由骨骼引起的脊柱良性肿瘤。流行病学存在显著的异质性,分子生物学,成像特征,以及这些病变的最佳治疗。例如,骨样骨瘤的特征是环氧合酶的高表达,使其最初适合使用抗炎药治疗,而其他病变如骨母细胞瘤可能需要更快的病灶内刮治或整块切除。一般来说,尽可能降低复发风险时,首选整块切除.Further,一些肿瘤可能出现在综合症的背景下,如在Ollier病或Maffucci综合征中出现的多发性软骨瘤,或者作为遗传疾病的一部分,例如遗传性多发性外生性骨软骨瘤。这些病变可能会出现局部疼痛,导致神经系统受损或在常规成像中偶然发现。Enneking分类和Weinstein-Boriani-Biagini系统通常用于对病变进行分类并协助手术计划。诸如射频消融和激光光凝之类的更新颖的技术已被应用于骨样骨瘤的治疗,并且可能在其他病变类型的治疗中具有实用性。多学科方法在脊柱良性病变的管理中至关重要,常规使用化疗和手术方法。