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Neoadjuvant denosumab for the treatment of a sacral osteoblastoma

  • Case Report
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Abstract

Purpose

To present a case of aggressive sacral osteoblastoma (OB) treated with neoadjuvant denosumab therapy and en bloc resection.

Methods

Case report of a 14-year-old male with an aggressive OB affecting the superior articular process of the left first sacral segment. The lesion was lytic and metabolically active and involved the left-sided posterior elements of S1–S3 with extension into the spinal canal, affecting the left S1, S2, S3, S4 and S5 nerve roots. He was treated for 1 month with neoadjuvant denosumab followed by en bloc resection.

Results

Denosumab therapy caused regression of the tumour and converted the diffuse infiltrative mass into a well-defined solid (osteoma-like) structure, aiding surgical resection and preserving the S1, S4 and S5 nerve roots. Histologically, the treated lesion showed abundant sclerotic woven bone and osteoblasts with absence of osteoclasts.

Conclusions

A short course of denosumab caused tumour regression, ossification and conversion of an aggressive OB into a sclerotic, well-defined lesion thus aiding surgical resection and preservation of neural structures. Neoadjuvant therapy reduced osteoclast numbers but PET showed that the lesion remained FDG avid post-therapy.

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Acknowledgements

Glynny Kieser for her editorial input and Sarah Turton for typing the manuscript.

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Authors and Affiliations

  1. Division of Spinal Surgery, University of Oxford, Oxford, England, UK

    Jeremy J. Reynolds, Dominique A. Rothenfluh, Nick Athanasou, Shaun Wilson & David C. Kieser

  2. Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury District Health Board, 2 Riccarton Avenue, Christchurch, 8011, New Zealand

    David C. Kieser

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  1. Jeremy J. Reynolds
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  2. Dominique A. Rothenfluh
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  3. Nick Athanasou
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  4. Shaun Wilson
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Correspondence to David C. Kieser.

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Reynolds, J.J., Rothenfluh, D.A., Athanasou, N. et al. Neoadjuvant denosumab for the treatment of a sacral osteoblastoma. Eur Spine J 27 (Suppl 3), 446–452 (2018). https://doi.org/10.1007/s00586-018-5461-z

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  • DOI: https://doi.org/10.1007/s00586-018-5461-z

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