14 year old back pain

Chest radiograph – There is compression fracture of the T9 vertebra with lucent expansion of the left pedicle. The heart and lungs are unremarkable. The CT showed pathological fracture of the T9 vertebra with soft tissue replacement of the bony trabeculae within the body and posterior elements. There is also extension into the central canal that is better appreciated on MRI. Increased T2W signal and effacement of the anterior and posterior CSF spaces as well as the posterior epidural fat plane.

Infection, metastases, eosinophilic granuloma, lymphoma/ leukaemia, trauma and tuberculosis. 

osteoblastoma

Osteoblastoma is histologically similar to an osteoid osteoma except that it is much larger. The tumour is bone and osteoid forming and is comprised of osteoblasts. There is high associated vascularity. Although it can occur in any bone, it is more often seen in the spine. Earlier studies show that over 90% originate in the posterior vertebral elements, with a third extending into the vertebral body.

Lesions are predominantly lytic, with a rim of reactive sclerosis and tend to be expansile in over 90%. Internal calcification may sometimes be present and an associated soft tissue mass may also be present. It demonstrates a rapid increase in size with associated cortical expansion in the vast majority of patients, sometimes with cortical destruction. There may be a secondary ABC in 20%. Unlike in osteoid osteomas, characteristic pain relieved by aspirin may be lacking.

• Kroon, Herman M., and J. Schurmans. “Osteoblastoma: clinical and radiologic findings in 98 new cases.” Radiology 175.3 (1990): 783-790.