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Sacral osteoblastoma masquerading as sacroiliac joint dysfunction: A case report.

William J Hanney1, Morey J Kolber2, Abigail W Anderson1

  • 1School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, FL, USA.

Physiotherapy Theory and Practice
|January 6, 2026
PubMed
Summary

Rare spinal osteoblastoma can mimic common back pain. Persistent pain unresponsive to conservative treatment, especially with neurological symptoms, warrants advanced imaging to rule out serious conditions like this sacral tumor.

Keywords:
Low back painaneurysmal bone cystconservative treatment failureosteoblastomasacral tumor

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Area of Science:

  • Orthopedics
  • Neurosurgery
  • Radiology

Background:

  • Lumbosacral pain is frequently mechanical, but rare tumors like osteoblastoma can present similarly, causing diagnostic delays.
  • An 18-year-old male with persistent right-sided lumbosacral pain initially diagnosed with sacroiliac joint dysfunction did not improve with conservative care.

Purpose of the Study:

  • To highlight the importance of considering red flags in persistent back pain.
  • To illustrate a case of osteoblastoma mimicking benign spinal pain.

Main Methods:

  • A case presentation of an 18-year-old male with recalcitrant lumbosacral pain.
  • Diagnostic workup included magnetic resonance imaging (MRI), computed tomography (CT), and CT-guided biopsy.
  • Surgical excision of the sacral tumor with nerve root decompression was performed.

Main Results:

  • Imaging revealed a sacral osteoblastoma with aneurysmal bone cyst features.
  • Surgical intervention was successful, with no recurrence at 1-year follow-up.
  • The patient achieved symptom resolution and returned to pre-morbid function.

Conclusions:

  • A poor response to conservative management for lumbosacral pain should prompt further investigation with imaging.
  • Considering rare diagnoses like osteoblastoma is crucial when standard treatments fail.