Imaging of primary vertebral tumors and tumor-like lesions in skeletally immature patients: a pictorial review.

Primary vertebral tumors and tumor-like lesions in skeletally immature patients are uncommon yet clinically consequential causes of pain, deformity, and neurological compromise. Compared with adults, pediatric lesions arise in a spine with open physes, evolving marrow composition, and substantial remodeling capacity-features that shape tumor biology and imaging appearance. This pictorial review summarizes malignant tumors, benign tumors, and tumor-like lesions of the pediatric spine, adopting a modality-first, compartment-aware approach. Useful highlights include vertebra plana in Langerhans cell histiocytosis, posterior-element bias in lesions such as osteoid osteoma/osteoblastoma, and the role of whole-body magnetic resonance imaging patterns in chronic nonbacterial osteomyelitis/chronic recurrent multifocal osteomyelitis. We also update terminology and concepts for entities such as vertebral hemangioma (venous malformation) and aneurysmal bone cyst. Throughout, we couple modality choice with pediatric anatomy and growth considerations, as well as illustrating the discussion with real-life cases from our teaching files.