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Adolescent girl with back pain

Q1: What abnormalities are seen on the radiological investigations (see figs 1–3; p 432)?
The plain radiograph shows a right thoracolumbar scoliosis with apex at L2. The bone scan shows intense activity over left side of the second lumbar vertebra. The computed tomogram shows widened left superior articular facet (black arrow) of L2. A lesion with a central nidus and surrounding sclerosis is seen. The inferior articular facet (white arrow) is normal. Radiographs of her pelvis (not shown) confirmed that she was skeletally mature.

Q2: What is the likely diagnosis and how does it usually present?
The diagnosis is osteoid osteoma involving the left superior articular facet of L2 vertebra. Osteoid osteomas are benign bone tumours. The lesion commonly presents between the ages of 10 and 25 years and has a male preponderance.¹ The proximal femur is the commonest location followed by tibia and the posterior arch of vertebra.² Patients with lesions in the spine typically present with painful scoliosis and, less commonly, with varying degrees of radicular leg pain.¹ The pain is usually severe, frequently . . . [Full text of this article]

Relevant Article

Adolescent girl with back pain

B Theruvil, V Kapoor, and N R Boeree
Postgrad. Med. J. 2004 80: 432. [Extract] [Full Text] [PDF]