Benign Tumors of the Spine
Most common benign lesion of bone and 7% have spine involvement. It is abnormal growth of normal skeletal tissue. Treatment is only indicated when there is neurologic involvement.
Osteoid osteoma’s are tumors smaller than 2 cm. Occurs in 2nd and 3rd decades, usually in males. Night pain is common and uniquely treated with over the counter medicines such as aspirin and ibuprofen. When the tumor grows to > 2cm the name changes to osteoblastoma. Both lesions are known to cause scoliosis (which resolves if treatment initiated within 15 months to two years of symptoms). Treatment usually involves surgical excision, however, recently non-invasive radiofrequency ablation has been found to be a promising treatment but carries with it the risk of injury to surrounding nervous structures.
ANEURYSMAL BONE CYST
These are rare lesions with 80% occurring in patients under age 20. The most common symptom is pain on presentation. The x-rays have a very distinct appearance as does the MRI. ABC’s commonly present in light of another tumor and should always raise the suspicion of another lesion. Excision leads to an 87% cure rate.
GIANT CELL TUMOR
Represent 10% of all bone tumors with spine involvement in 3-6%. They are slow growing but locally aggressive tumors. The most common presentation is pain and 1/3 of patients present with neurologic deficits. Surgical resection leads to a high cure rate. If radiation is employed there is a 10% chance of the tumor to change to a more malignant variety. Occasionally radiation is required if complete resection is not possible.
More commonly presents in young children with vertebral involvement in 7-15% of cases. It has a distinct appearance on x-ray but must be distinguished from other lesions that may have similar findings. These tumors are best treated with immobilization and occasionally with radiotherapy.