A Girl with Lower Back Pain at Night and Scoliosis: Osteoblastoma as an Example of an Aggressive Benign Tumor

Back pain in children can occasionally be chronic and relentless. When it occurs at night, has neurological symptoms or findings, is associated with a large degree of scoliosis or atypical scoliosis, or is seen in a young child, there is further cause for concern. Pain at night may be indicative of inflammation, from either infection or a tumor. Neurological findings suggest that there is a physical or structural explanation such as nerve compression, irritation, or stretch. Back pain in a young child under age 10 years is further reason for concern. History, physical examination, and careful review of plane radiographs are essential when evaluating a child with these types of symptoms and findings. Although rare, osteoblastoma is a classic lesion of the posterior elements of the spine that may have a constellation of these types of symptoms. Since osteoblastoma is a relatively large lesion, greater than 2 cm, and is associated with excess bone formation, it can be diagnosed on mindful review of plain radiographs. Refer to surgeon with pediatric spine experience.