Benign Tumors of the Vertebral Column

From WikiCNS
Jump to: navigation, search
Checkmark.gif This article has been reviewed by the NeuroWiki Editorial Board


Contents

Back pain in the young population is commonly a result of trauma or physical overuse. However, persistent and/or progressive back pain warrants an evaluation for the following skeletal conditions in children:

  1. Scheuerman's Disease
  2. Spondylolisthesis
  3. Herniated disc
  4. Spondylolysis
  5. Osteomyelitis or discitis
  6. Spondyloarthropathy
  7. Trauma
  8. Benign bone tumors
  9. Malignant bone tumors
  10. Spinal cord tumors
  11. Metastatic tumors

Spinal tumors are uncommon in children. 70% of primary bone tumors are benign and 40 % of those are osteoid osteomas, osteoblastomas, osteochondromas, and aneurysmal bone cysts. Pain is the common symptom. Pain that is progressive, unrelenting and occurs at night should cause concern. Progessive, painful scolosis is not uncommon. Radiculopathy, long tract signs, and change in bowel or bladder are concerning for expansion into the neural canal or foramina.

Osteoid Osteoma (OO) and Osteoblastoma (OB)

Similarities

  • the most common cause of painful scoliosis in adolescence, OO>OB
  • histologically similar and related
  • majority involve the posterior elements, vertebral body destruction is rare
  • majority lie within the lumbar spine >thoracic>cervical and sacral
  • most diagnosed within 2 years of symptoms
  • Radiographic evaluation: bone scan is most sensitive. CT to examine bone borders and MRI for neurological deficits.

Differences

Osteoid Osteoma

Osteoblastoma

Percent of Primary bone tumor

11%

<5%

Percent occurring in spine

10%

>40%

Size

< 2 cm

> 2 cm

Patient age at Diagnosis

6-17 years

10-15 years

Pain

May occur at night

No definite time

Relief of pain

May be relieved by aspirin or non-steroidal anti-inflammatory

Not relieved by anything consistently

Radiculopathy

Rare

Can occur

Myelopathy

Rare

Can occur

Destruction of bone, expansion into spinal canal or involvement of adjacent VB

Rare

Can occur

Radiographic appearance

Radiolucent nidus surrounded by sclerosis

Slow growing expansile, destructive lesion. Calcifications are present

Malignant transformation

No

Yes. Osteosarcoma differentiation or metastasis may occur.

Treatment

Treatment of pain may be sufficient. Otherwise complete surgical removal. Redo extirpation for recurrence.

Surgical Extirpation. Redo extirpation for recurrence. Radiation is last resort.

Recurrence rate with “total resection”

Almost 0%

10%

Improvement in scoliosis after treatment

If less than 15 months

unknown


Osteoid Osteoma spine[1]

Aneurysmal bone cyst

  • most commonly occur in the posterior elements of the lumbar spine in females between the ages of 5-20 years of age
  • Symptom: back pain or weakness from an affected nerve root
  • radiographs demonstrate an expansile osteolytic cavity with bubbly appearance. It is extremely vascular although angiograms are negative.
  • Histologically appears as fluid filled spaces separated by fibrous septae
  • Diagnosis should be made by open biopsy since they tend to hemorrhage
  • Treatment: complete excision with radiation as adjuvant therapy. Treatment should include embolization followed complete surgical removal. Rapid removal of the cyst lining will decrease the blood loss at time of surgery.
  • Recurrence rates are 10-25%. Treat with second removal. Radiation data is limited.

Eosinophilic Granuloma

  • benign, self-limited destruction of bone
  • age <10 years
  • vertebral body is most likely involved and it is common cause of “vertebrae plana” or “coin-on-end” appearance of the vertebral body
  • presents with localized pain, rare to have radiculopathy or myelopathy
  • lesion can heal without treatment. Neurological deficits or radiographic change mandates biopsy.
  • Vertebral body height may reconstitute
  • May be isolated EG, Hand-Schuller-Christian disease or Letterer-Siwe disease.

Osteochrondoma

  • solitary osteochrondomas are cartilaginous boney growths that initially appear in relation to the epiphyseal growth plate. It is not inherited.
  • Occur in the cervical and thoracic region
  • May grow large enough to cause cord compression
  • Surgical intervention is indicated for progressive pain, neurologic deficit and malignant transformation (rare).
  • No adjuvant treatment is necessary


Multiple Hereditary Osteochondromatosis (MHO)

  • AD transmission
  • Multiple cartilaginous protusions, common in the posterior elements of the cervical and thoracic region
  • Cord compression with symptoms can occur
  • Complete surgical removal is curative
  • Malignant transformation to chondrosacroma is rare, but possible

Giant Cell Tumors (GCT)

  • extremely rare in children as spinal involvement occurs in the later stages of disease.
  • histologically benign, clinical behavior is erratic. Can produce pulmonary mets
  • giant cell sarcoma is common and often appears at same time of GCT removal and RTX. No more than 30 Gy should be given
  • Stage I-III defines the surgical resection

Enchondromas

  • benign growths that arise from the growth plates and rarely (<1%) involve the vertebral body.
  • do not require treatment
  • sarcomatous degeneration is rare, but is seen in patient’s with Maffucci’s syndrome. These require removal and reconstruction.
Personal tools