1. BENIGN PRIMARY SPINAL BONY
TUMORS
Dr Sumit Sinha MS, DNB, MNAMS, MCh
Faculty, AO Spine
Faculty, Advanced Trauma Life Support
Fellow, Fujita Health University, Japan
Spine fellow, Pontificial Catholic university, Curitiba, Brazil
Associate Professor
Deptt of Neurosurgery, All India Institute of Medical Sciences
and Associated JPNA Trauma center, New Delhi
4. SPINAL BONY TUMORS
Osteoid osteoma
β’ Teens, males
β’ Spine- <10%
β’ <2 cm
β’ MC site- L spine- posterior
Elements
5. SPINAL BONY TUMORS
Osteoid Osteoma (Contd.)
β’ Backache-
β not relieved by rest
β Worse at night and with recumbency
β relieved by NSAID
β’ PAINFUL SCOLIOSIS in adoloscents
β’ Any back pain > 6 weeks in children/ young
adults- Tc Bone scan- increased uptake
6. SPINAL BONY TUMORS
Osteoid osteoma (Contd.)
β’ Radiology-
Round/ oval lesion- radiolucent center with
peripheral sclerosis; (< 2 cm diameter)
CT scan shows the nidus (arrowhead) with a
small area of calcification and no perinidal
sclerosis
7. SPINAL BONY TUMORS
Osteoid osteoma (Contd.)
Histology
β’ Background of vascularised
connective tissue with
trabeculation
β’ Surrounding reactive cortical bone
9. SPINAL BONY TUMORS
Osteoblastoma
β’ 2-3 decade; males>females
β’ 40% located in spine
β’ > 2 cm
β’ Pain- more constant, less severe, not nocturnal
(opposed to osteoid osteomas)- unresponsive to
NSAIDβs
β’ Treatment- complete surgical excision- wide en
bloc
10. SPINAL BONY TUMORS
Osteoblastoma (Contd.)
β’ X Ray- Expansile lesion with well circumscribed
margins and homogenous ossification
β’ CT-
hypoattenuating area with central
calcifications and minimal surrounding
sclerosis.
destructive expansile lesion with osteoid
matrix extending into the spinal canal.
11. SPINAL BONY TUMORS
MRI
Mass with low signal intensity
Axial contrast-enhanced fat-saturated T1-
weighted MR image shows marked
enhancement of the lesion
12. SPINAL BONY TUMORS
Bone-forming tumor with
irregular anastomosing trabeculae
(T) lined by regular osteoblasts
and osteoclasts (arrowheads) and
with rich vascularity (*).
Histology
13. SPINAL BONY TUMORS
Osteochondroma
β’ 2-3 decade
β’ 1/3 of all benign bony tumors
β’ 1-2% located in spine-
β LS (50%)
β TH (30%) posterior elements- spinous process
β CX (20%)
β’ Pathogenesis- abnormal cartilage growth
14. SPINAL BONY TUMORS
Osteochondroma- symptoms-
β’ Frequently asymptomatic
β’ Painless prominence of bone
β’ Pain- mild, increases with activity
β’ Associated with kyphosis and
spondylolisthesis
β’ Nerve/ spinal compression
20. SPINAL BONY TUMORS
Chondroblastoma- Radiology
Sagittal T2-weighted MR image,- lesion
(arrowheads) appears isointense relative to
the normal vertebral bodies
Axial contrast-enhanced fat-saturated T1-
weighted MR- marked enhancement
21. SPINAL BONY TUMORS
Chondroblastoma- Histology
sheets of uniform chondroblasts with
abundant chondroid matrix (*) and some
osteoclast type giant cells (arrowhead).
22. SPINAL BONY TUMORS
Vertebral hemangioma
β’ Dysembryogenetic/ hamartomatous
origin
β’ > middle age
β’ Slight female predilection
β’ Site- Th/ L spine.
β’ usually confined to the vertebral body, occasionally
extend into the posterior elements.
23. SPINAL BONY TUMORS
Haemangiomas- symptoms
β’ Mostly asymptomatic.
β’ Occasionally- increase in size and
compress the spinal cord and nerve roots
24. SPINAL BONY TUMORS
Radiology
Axial T2-weighted MR image- well-
circumscribed fatty lesion with coarse vertical
trabeculae (polka dots).
Hemangioma of the T9 vertebral body in an
81-year-old woman with multiple osteoporotic
compression fractures (T10βT12).
25. SPINAL BONY TUMORS
Haemangioma- Histology
thin-walled vessels lined by flat, bland
endothelial cells infiltrating the
medullary cavity between bone
trabeculae
26. SPINAL BONY TUMORS
Haemangiomas- Treatment
β’ Transarterial embolization- for painful
intraosseous hemangioma and for reducing
intraoperative blood loss before decompressive
surgery
β’ Surgery- Rapid tumor growth with spinal cord
compression
27. SPINAL BONY TUMORS
Fluid levels- heterogenous signal T1/T2
Cystic expansile lytic lesion- thin
cortical shell-
MC site- long bones/ spine-
thoracic vertebrae- posterior
elements
Aneurysmal Bone Cyst
Age- <20 yrs
Females >males
28. SPINAL BONY TUMORS
Aneurysmal Bone Cyst- histology
β’ histology
blood-filled cystic spaces separated by
a spindle cell stroma with osteoclast-
like giant cells and osteoid or bone
production
29. SPINAL BONY TUMORS
Aneurysmal Bone Cyst-Treatment-
β’ Embolisation only
β’ Embolisation β surgery
β’ Complete surgical excision
β’ RT- for residual/ recurrent tumors
30. SPINAL BONY TUMORS
Giant cell tumors-
β’ 2-4th decade
β’ Females common
β’ Sacrum (MC Site)- upper part/ wing>L>Th>Cx
β’ Intervertebral disk invasion and extension into an
adjacent vertebra
31. SPINAL BONY TUMORS
well-defined lytic lesion of the right
upper part of the sacrum with
extension through the right sacroiliac
joint and absence of a sclerotic rim.
32. SPINAL BONY TUMORS
Giant cell tumors-
β’ Histology
osteoclast type giant cells with
numerous nuclei (*) scattered among
regular mononuclear cells.
33. SPINAL BONY TUMORS
Langerhans cell histiocytosis (histiocytosis X)-
β’ eosinophilic granuloma- usually solitary and
curable
β’ SchΓΌller-Christian syndrome- Disseminated
process
β’ Letterer-Siwe disease- Rapidly fatal
β’ 5 and 10 years
β’ Vertebral involvement- 7.8%β25%
35. SPINAL BONY TUMORS
Treatment
β’ Controversial.
β’ Conservative- Patients without complications
β’ In patients with multifocal disorders- biopsy of
extraspinal lesions and chemotherapy
