Primary tumors of the Spinal column are uncommon but may be seen in children when they present with pain and progressive neurological deficits like paraplegia as in the case demonstrated.
Osteoid osteoma and Osteoblastoma were originally felt to be variations, predominantly of size, of the same tumor type. However, current clinical consensus is that these are two separate entities with different clinical and radiologic characteristics as well as different risks of progression.
Osteoblastoma is a rare primary tumor, accounting for one percent of all Bone tumors and up to 3% of benign Bone tumors with 40% being located in the vertebral column.
Surgical resection is the mainstay treatment for spinal Osteoblastoma, with high recurrence rates with subtotal resection. As osteoblastomas typically involve the posterior elements of the spine, achieving a gross total resection or en bloc resection often involves removal of the facets or pedicles.
Histologically, they are composed of osteoid and woven bone, and frequently contain highly vascular regions and numerous osteoblasts. They most commonly affect the thoracolumbar spine, although frequent involvement of the cervical spine has also been reported. They have a greater incidence in males and are most commonly diagnosed in the second decade of life, with a prolonged duration of symptoms prior to presentation of up to an average of 20 months. Patients typically present with localized pain in the neck or back, the pain may increase nocturnally. It typically improves with aspirin or non-steroidal anti-inflammatory drugs (NSAIDs).
Patients rarely present with preoperative spinal instability, but surgical fusion is often required due to removal of structural elements of the spine during resection. Of note, osteoid osteoma may progress to osteoblastoma in the spine despite prior resection.