"Occult" Roentgenographic Osteoblastoma of the Cervical Spine

A 33-yr-old man presented with a 4-yr history of neck pain. Previous work-ups, including planar radiographs and magnetic resonance imaging, were determined as "normal" by six previous consultants. In a subsequent in-office evaluation by a physiatrist, a vertebral osteoid osteoma or carotid artery angiitis was clinically suspected. A bone scan of the cervical spine was consistent with a the presence of an of osteoid osteoma. Thereafter, repeat magnetic resonance imaging confused the issue by suggesting the presence osteomyelitis involving the C3-C4 facet joint. Spiral cervical spine computed tomography with digital reconstruction once again demonstrated the presence of an osteoblastoma. The patient was subsequently referred to a spinal surgeon for biopsy and resection, which confirmed the presence of an osteoblastoma. Although benign cervical neoplasms presenting as neck pain occur most often in a pediatric population, at any age, the differential diagnosis of intractable neck pain should include the possibility of a primary osseous or metastatic tumor.