Benign Tumors of the Spinal Column

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Benign tumors of the axial skeleton are most commonly found in children and adolescents. When they occur in adults, they are generally found in individuals between 20 and 30 years of age, in a posterior location. The more common types of benign lesions - osteochondroma, osteoid osteoma and osteoblastoma - have a lower incidence of recurrence if a complete excision can be obtained. Unlike malignant tumors that require resection of a wide margin of normal tissue surrounding the lesion, resection of the benign tumor itself is usually curative. There are other "benign" tumors that can be associated with systemic disease, occur in multiple locations or are locally aggressive, including eosinophilic granulomas, giant cell tumors, aneurysmal bone cysts and hemangiomas, respectively.

Osteochondroma is a cartilage-capped, bony protuberance that is thought to develop from an adjacent physis or a cartilaginous remnant of the physis. Osteochondromas are the most common of the benign bone tumors. Over 50% of symptomatic spinal lesions occur in the cervical region, and they almost always involve the posterior elements. Osteochondromas can be a manifestation of multiple hereditary osteo-chondromatosis, which is one of the more common skeletal dysplasias. Clinical presentation varies from individuals reporting a dull backache (smaller tumors) to decreased motion or deformity (larger tumors). Neurological compromise is rare; however, when present, the cervical spine, followed by the thoracic spine, are the most common lesion locations, with resultant myelopathic symptoms. Plain radiographs demonstrate a protruding lesion, with well demarcated borders in the posterior elements. Treatment for this condition is usually observation, because the natural history is of very slow progression. On rare occasions, pain, neurological deficit or an accelerated growth pattern may necessitate surgical removal. Prognosis is usually excellent when complete curettage of the affected periosteum and surrounding cartilage is performed. Osteochondro-mas will occasionally degenerate into malignant chondrosarcomas (usually in patients with multiple lesions) [2-4].

Osteoid osteoma and osteoblastoma share a common pathologic origin but differ in size and incidence of spinal involvement. These tumors are thought to be a chronic inflammatory reaction rather than true neoplasms. Osteoid osteoma accounts for 2.6% of all excised primary bone tumors and up to 18% of axial skeletal primary lesions. By definition, osteoid osteomas are less than 2 cm in size; otherwise, the lesions are classified as osteoblastomas. Approximately 40% of spinal osteoid osteomas occur in the lumbar region, and the majority occur in the posterior elements. Most patients with symptomatic lesions are young and male. Half of all symptomatic lesions present in the second decade of life. On clinical presentation, patients report a dull ache, which is exacerbated at night. This condition is believed to be the result of prostaglandin production by the tumor - thus, the classic pain relief with aspirin. Neurological deficits are rare but osteoid osteoma is the most common lesion of painful scoliosis in adolescents. Radiologically, a radiolucent area with a central nidus and an appropriate degree of surrounding sclerosis

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