A 14-year-old boy complained of neck pain which lasted for half a year. Deformation of the transverse process of the first thoracic vertebra was initially not noted . MRI scan was performed 11 months later. It revealed the presence of a tumor in the first thoracic vertebra. A CT-guided biopsy confirmed the diagnosis.
A 14-year-old boy complained of pain in his upper back and neck, which lasted for half a year. Pain was not associated with stress and worsened during the nights and mornings. A radiograph of the cervical spine was taken initially, which suggested normal findings. After four months, the patient developed scoliosis and a radiograph of the scoliosis was taken, which was also interpreted as normal. Retrospectively, deformation and expansion of the left transverse process could be seen on the radiographs. The pain persisted and a MRI scan was performed 11 months after the initial radiograph was taken. It revealed the presence of a tumor in the first thoracic vertebra. The tumor was of intermediate signal on T2-weighted images, bright on T2*-weighted images and dark on T1-weighted images. It enhanced homogeneously after gadolinium injection. The tumor covered almost the entire body of the first thoracic vertebra. The left part of the T1-vertebral body had collapsed and the tumour was also growing to the posterior arch and to the transverse and spinous processes of the T1-vertebra. An expansile tumor obliterated the foramen of the left C8 nerve. A CT-guided biopsy was performed to obtain a sample of the tumor. The CT findings revealed an uninterrupted, mild periosteal reaction around the tumor.
Osteoblastoma, osteoblastic osteoid tissue–forming tumor, is believed to be a relatively rare benign bone neoplasm, constituting approximately 1% of the primary bone lesions. A conventional and aggressive type of osteoblastoma has been described. Osteoblastoma occurs primarily in the first two decades of life; the male/female ratio is 2:1. Approximately 30% of osteoblastomas occur in the spine, where they arise typically from dorsal elements. Osteoid osteoma and osteoblastoma are thought to be variant manifestations of the same osteoblastic process. The primary difference between the two lesions is the tendency of the osteoblastoma to form a less sclerotic, more expansile mass. Also the size of the lesion helps in differentiating them: lesions less than 1.5 cm (or 2 cm) in diameter are osteoid osteomas and the ones larger than them are osteoblastomas. Local or radicular pain is the characteristic presenting feature of both osteoid osteoma and osteoblastoma. Osteoblastoma is more expanding in nature and can narrow spinal canal or neural foramina. Typically, the diagnosis is established by a focal increase in osteoblastic activity on bone scintigraphy or by direct visualization on X-ray or computed tomography studies. The radiographic features of osteoblastoma are following; an expansion of the bone due to the presence of a tumor that has a narrow zone of transition, thin sclerotic margin and a lucent matrix, which is mixed or completely blastic. The periostic reaction was mild; however, radiographs are often non-diagnostic and very often bone tumors are missed in spine radiographs, as in this case. Magnetic resonance imaging provides information on the extent of the lesion, but MR appearance is also non-specific, being of low signal intensity on T1 and mixed to high on T2, and also the surrounding edema may be prominent. A biopsy of the lesion is necessary to provide tissue for histological diagnosis. The tumor was treated with curettage and bone grafting, and after one year there was no recurrence.
Osteoblastoma of the T1 vertebra.
Based on the provided MRI, CT, and X-ray images, the following observations are noted:
Considering the above imaging findings and clinical context, an osteoblastoma is more suggestive.
Taking into account the patient’s age (14-year-old male), persistent cervicothoracic pain, and pathology results from the CT-guided biopsy, the most likely diagnosis is “Osteoblastoma.”
Pathological confirmation is crucial in this case. The relatively large lesion diameter, expansile destruction, and thin sclerotic rim on imaging are also consistent with typical features of osteoblastoma.
The mainstay of treatment involves surgical removal of the lesion with subsequent reconstruction, including curettage (scooping out the lesion) and bone grafting. Depending on intraoperative findings, local fixation or fusion may be employed. Possible options:
Postoperatively, regular imaging follow-up (X-ray/CT/MRI) is recommended to detect any signs of recurrence.
Principle of rehabilitation exercise: proceed gradually, personalized for the patient, and avoid excessive load that could re-injure the operative site. Adhere to the FITT-VP approach (frequency, intensity, time, type, progression, individualization).
Throughout the rehabilitation process, closely monitor cervicothoracic pain and any neurological symptoms. If severe pain escalation or nerve compression signs appear, prompt reevaluation and adjustment of rehabilitation strategies are needed. Protect the surgical site and avoid vigorous activities or heavy loads that may overly stress the spine in the short term.
This report is based solely on the current medical history and imaging data, serving as a reference opinion. It does not replace in-person consultation or individualized treatment recommendations from professional physicians. For any additional concerns, please consult an orthopedic and spine specialist and arrange regular follow-up visits.
Osteoblastoma of the T1 vertebra.
