Other Pseudotumoral Lesions of the Spine

A wide variety of benign nonneoplastic bone lesions in the spine may mimic benign and malignant bone tumors. These lesions are often incidentally discovered but may also be symptomatic and diagnosed after focused imaging evaluation for pain or other symptoms. Some of these lesions (e.g., normal variants or developmental abnormalities) require no further workup once recognized. Other skeletal processes, such as stress fractures or osteomyelitis, may require semi-urgent management to prevent complication. Some osseous abnormalities may be the first indication of a more serious systemic process that warrants further evaluation and treatment. Familiarity with the spectrum of imaging features of these lesions is necessary to direct appropriate workup and management and, importantly, to avoid unnecessary tests and procedures that might result in patient morbidity. This chapter reviews the imaging characteristics and differentiating imaging features on different modalities especially including conventional radiography, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine of nonneoplastic lesions that could be seen in everyday practice. In most instances, the clinical history will be important in determining the true nature of the lesion.