Abstract
Background:We present two patients with osteoid osteomas of the lumbar spine to highlight the delay in diagnosis and the utility of precise radiological localization enabling tumor resection without jeopardizing spinal stability.Case Description:Two young patients with refractory back pain presented after having undergone a year of conservative treatment for presumed mechanical back pain. The presence of “red-flag” symptoms (e.g. rest and night pain, and transient pain relief with aspirin) led to the performance of an isotope bone scan, and subsequent computed tomography (CT), which were both consistent with the diagnosis of an osteoid osteoma. After accurate CT-based preoperative planning for tumor excision, a customized conservative surgical technique was utilized that included marginal en-bloc surgical resection of the tumors. As the intervertebral facet joints were also carefully preserved along with stability, no accompanying instrumented fusion was warranted. Both patients returned to full function with complete resolution of their long-standing back pain of more than 2 years.Conclusions:The diagnosis of osteoid osteoma of the spine requires a high index of clinical suspicion. Diagnostic evaluations should include thin-slice CT scan to assist in planning the most restricted/conservative en-bloc surgical resection while preserving vertebral stability with facet preservation, and thus avoiding instrumented fusions. Without the availability of percutaneous radiofrequency ablation, such restricted/conservative approaches to osteoid osteomas are viable options in countries with developing economies.
Highlights
ConclusionsThe diagnosis of osteoid osteoma of the spine requires a high index of clinical suspicion
We present two patients with osteoid osteomas of the lumbar spine to highlight the delay in diagnosis and the utility of precise radiological localization enabling tumor resection without jeopardizing spinal stability.Case Description: Two young patients with refractory back pain presented after having undergone a year of conservative treatment for presumed mechanical back pain
A benign bone tumor characterized by a nidus of vascular osteoid tissue surrounded by a margin of dense sclerotic bone,[5] accounts for 2.5-5% of all bone tumors, 10-14%
Summary
The diagnosis of osteoid osteoma of the spine requires a high index of clinical suspicion. Surgical Neurology International 2014, 5:24 of which involve the spine As these tumors are rare, and the symptoms (e.g. pain over the vertebral column, worse at night, relieved by aspirin/NSAIDS, and/or referred along the trunk/lower extremity) are misinterpreted as radicular; the correct tumor diagnosis may be delayed. Worse at night, unrelated to activity, but characteristically relieved promptly with NSAIDS He was misdiagnosed for over a year, and prescribed physiotherapy, analgesic/antiinflammatory therapy, and trycyclic antidepressants without improvement. At 12 postoperative weeks, the X‐rays documented full incorporation of the bone graft [Figure 1d] In his last follow‐up at 9 years, he was completely pain‐free and had full function of the spine.
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