Updated: 6/24/2021

Pathologic Scoliosis

0%
Topic
Review Topic
0
0
0%
0%
Flashcards
2
N/A
N/A
Questions
2
0
0
0%
0%
Evidence
5
0
0
Topic
Images
https://upload.orthobullets.com/topic/2059/images/scoli axial.jpg
https://upload.orthobullets.com/topic/2059/images/osteoid osteoma.jpg
https://upload.orthobullets.com/topic/2059/images/oo spine.jpg
https://upload.orthobullets.com/topic/2059/images/patho scoli ap.jpg
  • summary
    • Pathologic Scoliosis is a form of scoliosis resulting from a benign bone tumor most commonly located in the posterior elements of the spine.
    • Diagnosis is made with full-length standing spine radiographs to determine the severity of the curve. A CT scan is useful to assess for the size and location of the underlying lesion.
    • Treatment is observation and NSAIDs for small and minimally symptomatic curves. Surgical resection of the lesion is indicated for painful, progressive scoliosis.
  • Epidemiology
    • Demographics
      • can occur in all age groups
  • Etiology
    • Causes
      • osteoid osteomas
        • occur in the apex of the concavity of the curve
        • curves are typically rigid
        • can occur in the vertebral body or posterior elements
        • demonstrate same histology as osteoid osteomas in the peripheral skeleton
      • osteoblastomas
        • larger lesion than osteoid osteoma
        • pain is usually less severe than osteoid osteoma
    • Mechanism
      • scoliosis is thought to develop in response to painful paraspinal muscle spasms
  • Presentation
    • Symptoms
      • back pain
        • most commonly at night
      • pain relieved by anti-inflammatories
        • less relief reported with osteoblastomas
    • Physical exam
      • posterior trunk
        • curvature of the spine
          • usually mild
      • neurological exam
        • may have neurological deficits with osteoblastoma
          • findings dependent on level of lesion
  • Imaging
    • Radiographs
      • AP/Lateral of spine
        • can determine level and severity of curvature
      • findings
        • lesion is defined by cortical thickening with radiolucent nidus
          • osteoid osteoma is less than 2 cm in diameter by definition
          • osteoblastoma is greater than 2 cm
    • CT scan
      • fine cut best for outlining lesion and determining treatment plan
    • MRI
      • good for showing proximity to neurovascular structures
      • may only show soft tissue edema and not the nidus
    • Bone scan
      • markedly increased uptake in area of lesion
  • Treatment
    • Non-operative
      • NSAIDs, observation
        • indications
          • minimal curve
        • outcomes
          • may take up to 36 months to resolve
          • osteoblatomas usually do not respond to NSAIDS
    • Operative
      • en bloc resection of lesion
        • indications
          • painful, progressive scoliosis
        • outcomes
          • resolution of curve if removed with 15-18 months of onset of curve in child less than 11 years old
      • radiofrequency ablation of lesion
        • indications
          • usually not an option due to proximity of neurological structures of spine
            • case by case basis based on 3D studies (CT, MRI)
  • Prognosis
    • Outcomes good with treatment
      • most cases of scoliosis due to osteoid osteoma will resolve after resection of tumor if
        • performed within 15-18 months of onset of curvature
        • child is less than 11 years of age
Flashcards (2)
Cards
1 of 2
Questions (2)

(OBQ13.129) A 13-year-old premenarchal girl presents with back pain and scoliosis. Figures A through D are the bone scan, SPECT scan, axial and coronal images respectively. What is the most likely diagnosis?

QID: 4764
FIGURES:
1

Metastasis

1%

(24/4114)

2

Aneurysmal bone cyst

3%

(115/4114)

3

Osteoblastoma

9%

(367/4114)

4

Osteoid osteoma

85%

(3510/4114)

5

Eosinophilic granuloma

1%

(58/4114)

L 2 B

Select Answer to see Preferred Response

(OBQ10.156) Which of the following statements regarding osteoid osteomas in the spine is correct?

QID: 3244
1

Scoliosis caused by osteoid osteoma is typically a flexible curve

19%

(608/3211)

2

Osteoid osteomas in the spine cannot be treated by radiofrequency ablation

14%

(446/3211)

3

Spinal osteoid osteomas typically occur on the concave side of the curve

58%

(1876/3211)

4

Osteoid osteomas always occur in the vertebral body of the spine

3%

(102/3211)

5

Osteoid osteomas in the spine show more malignant histological behavior than those in the extremity

5%

(161/3211)

L 3 C

Select Answer to see Preferred Response

Evidence (5)
VIDEOS & PODCASTS (1)
EXPERT COMMENTS (4)
Private Note