Delayed diagnosis of spinal osteoblastoma presenting with radicular pain and scoliosis: A case report

Abstract

INTRODUCTION AND IMPORTANCE: Osteoblastoma is a rare benign bone tumor, accounting for 1 % of primary bone tumors, often affecting the spine and sacrum. Accurate diagnosis is essential for appropriate treatment and prognosis. CASE PRESENTATION: A 19-year-old male presented with two years of persistent nocturnal radicular and low back pain unresponsive to anti-inflammatory medications. Physical examination revealed a left-sided gibbosity and a positive Sonnette sign at lumbar levels L3-L4 and L4-L5 without neurological deficits. MRI and CT scans revealed anomalies in the right facet joint at L3-L4 and a lytic lesion at the L3 inferior articular process, suggestive of osteoblastoma. The patient underwent en bloc resection of the right L3 inferior articular process, decompression of the right L3 root, and tumor curettage. A unilateral fixation with pedicle screws was performed to prevent instability. Histological examination confirmed osteoblastoma. The patient's postoperative recovery progressed moderately, and he is actively participating in physical therapy, with continued follow-up planned to monitor for any potential recurrence or complications. CLINICAL DISCUSSION: Osteoblastoma diagnosis is based on clinical, radiological, and histopathological evaluation. It is important to distinguish osteoblastoma from similar tumors for appropriate management. Surgical intervention, including en bloc resection or curettage, is the treatment of choice based on clinical factors and tumor location. CONCLUSIONS: This case highlights the challenges in diagnosing spinal osteoblastoma, especially in young patients with persistent back pain. Early recognition, prompt intervention, and surveillance are critical for optimal outcomes.