PMC9282798_01
X-ray and MRI images; (a) AP view showing sclerosis of the left D12 pedicle, (b) lateral view showing radiolucent shadow in D12 superior articular process along, (c) sagittal T1WI showing hypointense lesion surrounded by isointense shadow, (d) sagittal T2WI showing hypointense shadow obliterating foramen, and (e) axial T1WI and (f): axial T2WI showing involvement of pedicle and part of endplate (white arrows).
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F1
X-rays showed a mixed sclerotic/lytic lesion involving the left D12 pedicle and superior articular process [Figures 1a and b]. T2WI) [Figures 1c-f].
CT images; (a) sagittal image showing floating foraminal nidus, (b) coronal image showing peridiscal osteophyte, and (c) axial image showing thinned out ballooned cortex (white arrows).
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F2
The CT scan showed; a floating foraminal radiolucent lesion, pedicular cortical ballooning, and breach with posterior element sclerosis plus peridiscal osteophytes. The enhanced study revealed a peripheral dense rim enhancement involving the superior articular process and superior end plate of D12 [Figures 2a-c]. These findings were consistent with the diagnosis of an osteoblastoma.
Intraoperative navigation and clinical images; (a) navigation-guided exact location of nidus, (b) burring superior articular process of D12, (c) excised nidus, and (d) postoperative O-arm 3D CT confirming complete excision of tumor.
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F3
Using O-arm navigation, the tumor was entirely excised (i.e., including the tumor nidus and intralesional curettage) and followed by a standard posterior midline pedicle/ screw/rod instrumented fusion from D11 to L1 level [Figures 3a-d, 4a].
(a) Postoperative X-ray showing absent nidus and proper implantation, (b) histopathological slide showing a neoplasm composed of interanastomosing trabeculae of woven bone lined by a single layer of osteoblast set within loose edematous fibrovascular stroma with no evidence of increase mitosis or necrosis consistent with osteoblastoma, and (c-f) 2 years postoperative CT images showing no signs of recurrence.
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F4
Using O-arm navigation, the tumor was entirely excised (i.e., including the tumor nidus and intralesional curettage) and followed by a standard posterior midline pedicle/ screw/rod instrumented fusion from D11 to L1 level [Figures 3a-d, 4a]. The histopathological evaluation confirmed the diagnosis of an osteoblastoma [Figure 4b]. The latest 2-year postoperative follow-up revealed that the patient was asymptomatic without tumor recurrent on the CT scan [Figures 4c-f].