Lytic Lesions of the Posterior Elements of the Spine

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The vertebra is divided anatomically into the vertebral body anteriorly and the neural arch posteriorly. The neural arch is composed of bilateral pedicles, pars interarticularis, and laminae; from the neural arch arise the spinous process, bilateral transverse processes, and bilateral superior and inferior articulating processes. These anatomic components are known collectively as the posterior elements of the vertebra. Together, the posterior elements protect the spinal cord and nerve roots, allow movement of the spine at the facet joints, and provide attachment points for the paraspinal musculature and ribs. Spinal lesions that typically affect the posterior elements are characteristically different from those that affect the vertebral body. Lesions that involve the posterior elements tend to be lytic, and they also tend to be benign more often than malignant. This article reviews lesions that classically arise from the posterior elements, mainly aneurysmal bone cyst, osteoid osteoma/osteoblastoma, myeloma, and osteochondroma; hemangioma, and giant cell tumor, which typically arise from the vertebral body but extend into the neural arch.

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