spine

Epidemiology

Uncommon

< 1% Primary bone tumour

Young boys

- second decade

Location

Similar to OO

Spine 30%

- especially posterior elements

Long bones 35%

Clinical

Back or limb pain

- pain less severe than OO

Region specific approaches

Theory

- want to traverse one muscle / one compartment

- keep away from NV bundle

- as a rule perform open biopsy through compartment the tumour is in

- this is the compartment that will require surgical removal in wide excision

- direct approach without going through muscle if possible i.e. tibia, distal ulna

Lower Limb

Thigh

AKA

Diaphyseal Aclasis / Multiple Osteochondromas

Definition

Heritable skeletal dysplasia

Epidemiology

AD with variable penetrance (96%)

Malignant Transformation

Incidence of malignant transformation much higher 

- 10% overall

- 1 % / year

Chondrosarcoma (CS) > Osteosarcoma (OS)

Definition

Lateral curvature of the spine 2° to vertebral anomaly

- causes an imbalance in longitudinal spine growth

Epidemiology

True incidence unknown

F > M

Typically Thoracic

Inheritance

No association in twins / suggests not inherited

5% risk in family if complex multi-level

Aetiology

Engelmann's Disease

Progressive diaphyseal dysplasia

- marked thickening of cortices of long bones

Present

Young child with gait disturbance and limb pain

Clinical

Bilateral symmetrical diaphyseal sclerosis of long bones

- Affects endosteal & periosteal new bone

- Metaphysis & epiphysis are normal

Skull base sclerotic

- can get blindness and deafness

Definition

Benign, bone-forming neoplasm

- characterized by a small nidus of neoplastic tissue

- surrounded by a wide zone of mature, reactive bone

Epidemiology

10% of benign bone tumours

Age 5-25

M:F 2:1

Aetiology

Unknown

- thought may be glomus tumour of bone

Pain secondary to prostaglandin production

Gout

No pathognomonic signs for gout

- identification of negative birefringent crystals under polarising light 

- trial of indomethacin if suspected

Inflammatory Bowel Disease / Enteropathic

Crohn's & Ulcerative Colitis

- spinal manifestation similar to Ankylosing Spondylitis

- 15-60% of IBD

Two different forms

- mild & asymptomatic