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Virtual Pediatric Hospital: Back Pain in Children: Case Examples of Back Pain in Children: Case 5 Back Pain in Children: Case Examples of Back Pain in Children

Case 5

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


11 year old female with progressive scoliosis for 2 1/2 years. Over the last few months, she developed back pain with her scoliosis which was relieved by aspirin. Physical exam was remarkable for a thoracolumbar scoliosis, convex to the right. She had a normal neurological exam. Clinical she was felt to have a tumor.

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This T12 lesion was removed in the operating room and was found to be an osteoid osteoma.

The most common form of scoliosis is idiopathic scoliosis, which is most commonly seen in adolescent girls. It is a thoracic scoliosis convex to the right. It should never be painful. Any scoliosis associated with pain needs further work up, starting with a bone scan. Causes of a painful scoliosis include osteoid osteoma / osteoblastoma, infection, histiocytosis X and aneurysmal bone cyst. In addition, a thoracic scoliosis convex to the left should also be worked up at they are often also associated with tumors.

Osteoid osteoma is a benign tumor containing osteoid in a stroma of loose vascular connective tissue. It arises in the posterior elements of the vertebral body. It is seen in children ages 6-17. Its pain is classically relieved by aspirin. If the lesion is less than 2.0 cm in diameter it is called an osteoid osteoma, if it is greater than 2.0 cm in diameter it is called an osteoblastoma. On plain films, the contralateral pedicle is often sclerotic, and the scoliosis is convex away from the side of the tumor. A bone scan shows increased uptake in the lesion. CT shows a small lucent nidus that can have calcification, surrounded by sclerosis. MRI has no role in the imaging of osteoid osteoma.

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