A 1983 CMCC graduate, Dr. Marshall Deltoff completed his radiology residency at Los Angeles College of Chiro- practic. He is a past radiology department chairman and resi- dency coordinator at CMCC, and he initiated the radiology curriculum at UQTR. Dr. Deltoff has lectured throughout North America, and is co-author, along with Dr. Peter Kogon, DACBR, of the radiology text “The Portable Skeletal X-ray Library” published by Mosby- Yearbook of St. Louis. Deltoff can be reached at: Images Radiology Consultants, 16 York Mills Road, Toronto, ON M2P 2E5 Tel: (416) 512-2225 Fax: (416) 512-2226 e-mail: [email protected] decreased upper cervical ranges of motion. The radiograph reveals a markedly enlarged posterior tubercle of atlas (5 cm in diam- eter), with abnormal internal trabeculation. Diagnosis: Osteoblastoma M Dr. DISCUSSION: – rare and benign; accounts for one per cent of all primary bone tumours – originally described as an “osteogenic fi broma of bone” in 1956; shares similar clinical and histological features with osteoid osteoma, giant cell tumour and fibrous dysplasia – commonly affects the vertebral column; 30 per cent in the posterior elements of the spine; also found in tubular bones – bone-forming lesion (many immature bony trabeculae, lined with osteoblasts, demon- strating various degrees of ossification) – may be cortical or medullary; when cortical, expansion is often present; may reach up to 11 cm in diameter!! (average 3.2 cm) – may present with neurological symptoms as a result of cord or nerve root compres- sion – no helpful lab tests; biopsy required to confirm diagnosis ON X-RAY: – usually well-circumscribed cortical lesion, with thin shell of peripheral new bone – lesion larger than 2 cm – internally, displays varying degrees of radiolucency depending on amount of ossifica- tion of the numerous immature trabeculae – may sometimes appear malignant, with adjacent cortical destruction and extraosseous soft tissue expansion – CT is helpful in the management of the lesion, to provide accurate information regard- ing the size and extent of the lesion THERAPY: – surgical resection; this is usually curative with good outcome• 50 • CANADIAN CHIROPRACTOR |FEBRUARY 2008 www.canadianchiropractor.ca y sincere thanks to my dear friend, colleague and classmate, Dr. Howard Fisher of Toronto, for providing me with this case. This 43-year-old woman presented with dull, achy sub-occipital pain, with Marshall Deltoff, DC, DACBR, FCCR(C)
Chiropractic + Naturopathic Doctor March 20008: Page 50
