Painful Scoliosis

Etiology: vertebral body tumor (osteoid osteoma / osteoblastoma, Langerhans cell histiocytosis), spinal cord tumor, infection
Imaging: scoliosis is convex to opposite side of lesion
Clinical: scoliosis should never be painful, should be investigated with CT

Radiology Cases of Painful Scoliosis

Radiograph and CT of osteoid osteoma of the spine — AP radiograph of the thoracic spine shows an indistinct margin of the left T10 pedicle and mild scoliosis convex right. Axial CT without contrast of the T10 vertebral body with coronal and sagittal 2-D reconstructions shows a small round lucent nidus with central calcification in the left T10 pedicle surrounded by sclerosis.

Plain film and CT and bone scan of osteoid osteoma of the spine — AP radiograph of the thoracic spine (left upper) shows a mild curvature of the spine convex right and the left pedicle of the T12 vertebral body is difficult to visualize. Axial CT without contrast of the T12 vertebral body (right upper) shows a lesion with a lucent nidus surrounded by a sclerotic rim in the left pedicle of the T12 vertebral body. Pinhole (left lower) and whole body (right lower) images from a nuclear medicine bone scan show focally increased radiotracer localization in the left pedicle of the T12 vertebral body and a curvature of the spine convex right.

Radiograph and CT of osteosarcoma of spine — AP and lateral radiographs of the lumbar spine taken during a CT myelogram show loss of height of the L3 vertebral body and sclerosis of its posterior elements. Axial CT myelogram through the L3 vertebral body shows lytic lesions in the vertebral body and an expansile sclerotic appearance of the posterior elements with periosteal reaction.