A spinal osteoblastoma in a child, situated in the vertebral body - CT and MR imaging

Abstract

Objective – To report a rare case of a lumbar spinal osteoblastoma involving only the vertebral body.

Case report – A 10-year-old boy presented with low back and leg pain, difficulty walking, limping with his right leg, discreet scoliosis on the left side, and lumbar paraspinal muscle spasms. The Lasegue sign for both sides was positive at around 45 degrees. Babinski’s sign and sensory changes were not noted. The boy was evaluated by X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) of the lumbosacral spine. CT and MRI scans revealed an expansile lesion that involved the posterior part of the L4 vertebral body, sparing the posterior osseus elements of the L4 vertebra. The lesion extended into the spinal canal, with compression of the thecal sac and the left L5 nerve root. MR images showed osseus edema of the remainder of the L4 vertebral body, enhanced homogeneously. Peritumoral edema extended into the epidural soft-tissue. Total removal of the tumor was performed. The histopathological finding was an aggressive osteoblastoma.

Conclusion – Spinal osteoblastomas are extremely rarely situated in the vertebral body alone. CT and MRI are very important methods for delineation of the location, osseous involvement, peritumoral edema and spread of the tumor in the epidural space, with the possible compression by the tumor of the neural elements of the vertebral canal. Total removal of the osteoblastoma is very important because some osteoblastomas may be aggressive, with a tendency to local recurrence and sometimes metastasis.