Updated: 10/5/2016

Pathologic Scoliosis

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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
Introduction
  • Painful, usually mild scoliosis resulting from a benign bone tumor most commonly located in the posterior elements of the spine. Causes include  
    • 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
  • Epidemiology
    • can occur in all age groups 
  • Mechanics
    • scoliosis is thought to develop in response to painful paraspinal muscle spasms
  • 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
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 1 cm in diameter by definition
        • osteoblastoma is greater than 1.5 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) 
 

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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? Tested Concept

QID: 4764
FIGURES:
1

Metastasis

1%

(20/3875)

2

Aneurysmal bone cyst

3%

(107/3875)

3

Osteoblastoma

9%

(345/3875)

4

Osteoid osteoma

85%

(3311/3875)

5

Eosinophilic granuloma

1%

(56/3875)

L 2 B

Select Answer to see Preferred Response

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

QID: 3244
1

Scoliosis caused by osteoid osteoma is typically a flexible curve

19%

(566/3009)

2

Osteoid osteomas in the spine cannot be treated by radiofrequency ablation

14%

(418/3009)

3

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

59%

(1768/3009)

4

Osteoid osteomas always occur in the vertebral body of the spine

3%

(92/3009)

5

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

5%

(148/3009)

L 3 C

Select Answer to see Preferred Response

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