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Updated: Jun 24 2021

Pathologic Scoliosis

Images axial.jpg osteoma.jpg spine.jpg 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
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