Bone tumours affecting the spine in children and adolescents

Children and adolescents may present with non-specific back pain, commonly associated with developmental or psychosocial factors and with a benign and self-limiting course. The assessment of a child with back pain can be challenging and requires skill and expertise coupled with a high index of suspicion. Tumours affecting the vertebral column or the spinal cord should be always considered in the differential diagnosis of back pain in young patients. Bone tumours involving the spine are usually primary and benign, with a favourable outcome if appropriate treatment is applied at an early stage. Any delay in diagnosis can lead to prolonged morbidity, as well as the development of spinal deformity. This can be either a painful scoliosis, which starts as an antalgic deformity but gradually becomes structural, or a deformity affecting the coronal and sagittal planes due to extensive osteolysis as the result of the destructive course of a neoplasm. Primary malignant bony tumours are less common, but are associated with more severe morbidity and often respond poorly to treatment, despite recent advances in surgical techniques, chemo- and radiotherapy. This review summarizes current knowledge concerning bone tumours of the spine and provides a rational approach to the evaluation and management of this group of patients.