Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 96. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 952 Section Tumors and Inflammation Case Introduction A 20-year-old girl presented with severe intermittent dorsal pain with occasional radiation into the ribcage. The patient was unsuccessfully treated with physiotherapy. The pain got progressively worse particularly during the night she was then referred for further evaluation. Standard radiographs of the thoracic spine were unremarkable although it was noted that she had a significant shift to the left side a . The patient noticed a decrease of symptoms when she took NSAIDs. An MRI scan demonstrated increased signal intensity in the posterior elements of T7 on the left side b c . The bone scan showed increased uptake in that region d . ACT scan showed the typical features of an osteoidosteoma with a hypodense lesion with a nidus e .The lamina was exposed for an excision biopsy. However since the nidus was clearly visible it was decided to remove it by curettage. The bed of the nidus was cleaned with a high-speed air drill. The patient s symptoms completely disappeared after the operation and she remained painfree during follow-up. In adults older than 35 years most spinal tumors are metastatic adenocarcinoma multiple myeloma osteosarcoma Spinal tumors exhibit a specific anatomic predilection Spinal tumors demonstrate a specific anatomic predilection. Osseous tumors of the anterior vertebral body are most likely metastatic lesions multiple myeloma histiocytosis chordoma and hemangioma. The most common osseous spinal tumors involving the posterior elements are aneurysmal bone cysts osteoblastoma osteoid osteoma PrimaryTumorsoftheSpine Chapter 33 953 Malignant osseous tumors occur much more commonly in the anterior than the posterior spinal elements. Age and tumor location help to classify tumor lesion Tumor Biology Molecular Tumor Biology Recent advances in basic research of musculoskeletal tumors revealed that the sheer complexity of the molecular process of carcinogenesis may be conceptually reduced to a small .
