Osteoid Osteoma Research Articles

Hip preservation in crisis: total hip replacement for osteoid osteoma-induced degeneration in a young adult

Osteoid osteoma is a small, benign tumor known for causing severe pain, especially at night. Intra-articular osteoid osteomas are rare and often misdiagnosed due to overlapping symptoms with other joint disorders like osteoarthritis or synovitis. These tumors require advanced imaging for accurate diagnosis and may necessitate surgical intervention when conservative treatments fail. A 22-year-old female presented with a four-year history of left hip and loin pain, initially treated with NSAIDs. Her symptoms progressively worsened, leading to imaging studies that revealed a sclerotic lesion in the hip joint. A biopsy confirmed osteoid osteoma, and due to the extent of joint damage, total hip replacement (THR) was performed. Postoperative recovery was excellent, with full functional restoration and no complications. This case illustrates the diagnostic and therapeutic challenges of intra-articular osteoid osteomas. THR proved to be a successful treatment in restoring function and alleviating pain, underscoring the need for early diagnosis and individualized surgical management in advanced cases.

Decreased volume of rectus femoris and iliocapsularis in patients with femoroacetabular impingement syndrome after primary hip arthroscopy

Purpose(1) to investigate the consecutive changes in hip muscle volume in patients with femoroacetabular impingement syndrome (FAIS) during the initial postoperative period, and (2) to determine the potential effect of the early changes in hip muscle volume on clinical outcomes.MethodsData between March 2021 and March 2022 was reviewed. Patients diagnosed with FAIS based on clinical symptoms and radiographic findings, and undergoing hip arthroscopic treatment were included. Exclusion criteria were incomplete MRI data, prior history of hip surgery, and concomitant hip conditions including hip osteoarthritis with a Tönnis grade > 1, avascular necrosis, Legg-Calvé-Perthes disease, osteoid osteoma, synovial chondromatosis, pigmented villonodular synovitis, and developmental dysplasia of the hip (DDH). MRI was performed preoperatively and 3, 6, 12-month postoperatively. Cross-sectional area (CSA) of hip muscles including rectus femoris (RF), iliocapsularis (IC), iliopsoas (IP), gluteus medius/minimus complex (G-med/min), and gluteus maximus (G-max) were collected on MRI. The CSA was corrected by body surface area (BSA). Preoperative and a minimum of 2-year postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), and international Hip Outcome Tool, 12-component form (iHOT-12) were collected. A multivariate linear regression model was built to determine the influence of the potential factors on postoperative PROs.ResultsA total of 76 patients were included in the study. Compared to the preoperative level, decreased volume of RF and G-max, and increased IC/RF ratio were observed at postoperative 3 months (all with P < .05). Both G-med/min and G-max presented decreased volume at postoperative 6 months (all with P < .05). G-med/min presented decreased volume (P = .001) at postoperative 12 months. Changes in RF at postoperative 3 months and 12 months were positively related to improvement of iHOT-12 (Beta = 0.371, P = .012 and Beta = 0.330, P = .026, respectively). Changes in IC at postoperative 6-month was positively related to improvement of mHHS (Beta = 0.367, P = .027) and iHOT-12 (Beta = 0.315, P = .044).ConclusionDuring the initial first year following arthroscopic treatment for FAIS, decreased volume of the RF and gluteal muscles was observed. Early changes in volume of RF and IC were positively correlated to the improvement of minimum 2-year PROs.Level of evidenceLevel IV; case series.

A Rare Case of Osteoid Osteoma of the Medial Cuneiform Bone at Tibialis Anterior Insertion Confirmed by Bone Scan SPECT/CT.

A 34-year-old man presented with progressive foot pain that was initially on the medial soft tissue but eventually localized to the medial side of midfoot. Despite undergoing various imaging tests and conservative treatments over 2 years, the patient remained undiagnosed. After 6 months, soft tissue and bone involvement were observed on the medial cuneiform. A needle biopsy was inconclusive. Since bone tumor is rare in the medial cuneiform, the patient was referred to our department for 99mTc-MDP bone scan. The imaging and clinical findings suggested osteoid osteoma as the likely diagnosis, which was confirmed as intraarticular nidus under tibialis anterior attachment, after surgical resection and pathological examination.

A comprehensive MRI analysis of osteoid osteomas in patients with diverse radiological features across various regions.

Magnetic resonance imaging (MRI), which does not involve ionizing radiation, is the preferred imaging modality for diagnosing osteoid osteoma (OO), an ailment more common in children and young adults. This study aims to perform a literature review and delineate the MRI findings of OO lesions in patients exhibiting varying radiological features across different regions. A retrospective study included 63 patients diagnosed with OO through MRI, assessed independently by two blinded radiologists using both standard and dynamic contrast-enhanced MRI techniques. After excluding 7 patients with prior biopsy, surgery, or RFA, the study included 56 patients with 57 lesions. Of 57 lesions evaluated, 50 were in long, and 7 in flat bones. One patient presented with two separate nidi within the intertrochanteric region. Most of the lesions, 49 (86%), were extra-articular, while 8 (14%) were intra-articular. The nidus was intracortical in 45 (78.9%) patients, intramedullary in 5 (8.8%), subperiosteal in 5 (8.8%), and endosteal in 2 (3.5%). Average nidus diameter was 7.02 ± 2.64 mm (3-12.6 mm). Central nidal calcification was present in 68.4% (n = 39) cases. Contrast enhancement was intense at 90.5%, moderate at 9.5%. Reactive sclerosis around the nidus was severe (50.9%), moderate (22.8%), and mild (26.3%). Bone marrow edema was severe (70.2%), moderate (14.0%), and mild (15.8%). Soft tissue edema was identified in 77.2% of all lesions. To minimize delays in diagnosis and treatment, radiologists should become acquainted with the typical OO MRI findings and the atypical MRI findings that might be mistaken for other conditions.

Osseous tumors of the foot, ankle, and lower leg: a cross-sectional observational study analysing 288 cases

BackgroundOsseous tumors of the foot and ankle are rarely encountered in general orthopaedic practice and represent only 3 % of osseous neoplasms. It can be difficult to distinguish between benign and malignant lesions, leading to misdiagnosis. Delays in diagnosis are the main cause of litigation in sarcoma of the extremities. Poor understanding of how sarcomas present in this region can lead to inappropriate initial procedures, limiting options for limb salvage and increasing rates of local recurrence. Our aim is to improve understanding of these rare tumors to reduce misdiagnosis and decrease the occurrence of inappropriate or unwarranted procedures. MethodsWe retrospectively analysed a prospectively maintained database of 288 new referrals to the West of Scotland regional musculoskeletal oncology service for osseous lesions of the foot, ankle and lower leg over a 10-year period. An analysis of patient demographics, presentation, anatomical location, diagnosis, classification, management and outcomes was performed. ResultsOf all new referrals, 52.4 % were diagnosed with primary benign osseous tumors, 8.7 % with primary malignant osseous tumors, 9.7 % with metastatic osseous lesions, and 29.2 % pseudotumors. The most common primary benign tumor in our population was osteoid osteoma (18.5 %), primary malignant tumor was osteosarcoma (32 %) and metastatic osseous lesions were from small cell lung cancer primary (14.3 %). In the foot and ankle, malignant bone tumors most commonly presented in the distal tibia and fibula (20 %). Rest pain was the most common symptom at presentation in all groups, followed by swelling. The average duration of symptoms was 5 months for malignant lesions before primary referral. ConclusionBone tumors in the foot and ankle remain a diagnostic challenge. We hope to have increased understanding of these rare lesions and have recommended a management protocol in order to reduce the number of inappropriate procedures performed, optimising clinical outcomes and reducing the cost of litigation to healthcare services. Level of EvidenceLevel III- Cross-sectional observational study

Arthroscopic Chondral Nail Fixation for Treating Acetabular Cartilage Delamination Results in Improved Pain Relief at Minimum 2-year Follow-up in Patients with Femoroacetabular Impingement Syndrome: A Propensity-Matched Study

PurposeTo investigate the clinical outcomes following arthroscopic chondral nail fixation for acetabular cartilage delamination (ACD) in patients with femoroacetabular impingement syndrome (FAIS), and the presentation of ACD on MRI at follow-up. MethodsA retrospective review was performed between March 2021 and March 2022 at our institute. Patients undergoing primary hip arthroscopy for FAIS and diagnosed with ACD intraoperatively were included. Exclusion criteria were incomplete data or loss of minimum 2-year follow-up, and concomitant hip conditions including hip osteoarthritis with a Tönnis grade > 1, avascular necrosis, Legg-Calvé-Perthes disease, osteoid osteoma, synovial chondromatosis, pigmented villonodular synovitis, and developmental dysplasia of the hip (DDH). Patients who underwent chondral nail fixation were matched 1:1 with a control cohort of patients who only underwent simple debridement. Preoperative and minimum 2-year postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), and percentage of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were collected and compared. MRI was performed preoperatively and at final follow-up to assess ACD. ResultsFifty-eight patients were included in the study (29 patients in each group). Both groups demonstrated improved VAS and mHHS following surgery (all with P < .05). The chondral nail group demonstrated better postoperative VAS (P = .022) compared to the control group, while the postoperative mHHS was comparable between the two groups (P = .852). No significant difference was found in the achievement of MCID between the two groups (all with P > .05). More patients in the chondral nail group achieved PASS of VAS compared to the control group (75.9% vs 48.3%, P = .030). No patient underwent revision surgery or conversion to total hip arthroplasty (THA). The chondral nail group demonstrated significantly higher rate of ACD healing on MRI compared to the control group (P < .001). ConclusionPatients undergoing arthroscopic chondral nail fixation for treating ACD demonstrated significant pain relief, more achievement of PASS of VAS, and higher rate of ACD healing on MRI compared to those undergoing simple debridement. Level of EvidenceLevel III; retrospective cohort study.

Surgical results in cases of osteoid osteoma: a single-center retrospective study

Aims: This study aims to evaluate the clinical, radiological, and histological findings of patients who were treated for osteoid osteoma and discusses the diagnostic stages and surgical results of patients treated for osteoid osteoma. Methods: A retrospective examination was made of 38 patients who were treated in the Orthopedics and Traumatology Clinic of the 3rd Step University Hospital and diagnosed with osteoid osteoma between January 2010 and January 2023. The patients' demographic data and clinical, radiological, and histopathological evaluations were recorded. Results: In the surgical treatment of the 38 patients in this study, the nidus was excised with the en-bloc resection method or burr-down-assisted intralesional curettage. In the follow-up examination, a patient had a superficial wound site infection on the 14th day postoperatively, and daily dressings and antibiotic treatment were recommended. A significant decrease in pain was observed in 35 patients at the end of the month. In 2 patients, the pain had not recovered at the end of 6 months follow-up. After the second operation, all patients experienced significant relief from pain. Conclusion: Osteoid osteoma is a benign osteoblastic tumor primarily affecting young adults. Despite its benign nature, it often presents with localized nocturnal pain that is relieved by anti-inflammatory drugs. Treatment must be the complete removal of the nidus. Treatment options are evaluated according to the anatomical localization of the lesion.

Cryoablation of osteoid osteomas: Is it a valid treatment option?

Osteoid osteoma is a benign bone tumor with characteristic clinical symptomatology. The selected method for its treatment is percutaneous radiofrequency ablation. However, percutaneous cryoablation is an alternative method with certain advantages. To evaluate percutaneous computed tomography (CT)-guided cryoablation for the treatment of osteoid osteoma in young patients and adults. A total of 25 patients were treated with percutaneous CT- guided cryoablation for osteoid osteomas between October 2020 and March 2023 at a single institution. All patients were above 14-years-old (mean age, 24-years-old), and all procedures were performed under local anesthesia. Of the 25 patients, 8 were female and 17 were male. Tumor sites included the femur (n = 9), medial malleolus (n = 4), sacral ala (n = 4), facets (n = 4), humerus (n = 3), and tibia (n = 1). One cryoprobe was used in each procedure and, when possible, the lesion was covered by the ice-ball using an extraosseous position without penetrating the nidus. All necessary thermal protective techniques were used depending on the anatomical structure at risk. All patients treated had complete response (100% clinical success rate) starting on the day of the procedure. Technical success was achieved in all cases. Visual analog scale (VAS) scores at 1 year were 0, compared to a mean VAS score of 8.5 ± 1 (SD) before the procedure. No recurrences were reported at the 1-year follow-up and no complications were observed. In 11/25 cases, an extraosseous position of the cryoprobe was used with less procedural time achieving technical and clinical success and no complications with less patient discomfort. All patients were discharged from the hospital on the same day as the procedure. Cryoablation of osteoid osteomas is an efficacious and safe procedure with durable clinical results. Its greatest advantage is that the procedure can be performed under local anesthesia using an extraosseous position of the cryoprobe when possible.

Our Single Center Experience in Osteoid Osteoma Patients Treated with CT-Guided Percutaneous Radiofrequency Ablation Treatment and Follow-up.

Introduction Osteoid osteoma (OO) is a painful benign bone tumor. Typically, it causes pain that is most noticeable during the night, which is improved by nonsteroidal anti-inflammatory drugs. In the treatment of symptomatic lesions, open surgery for nidus removal is the gold standard. However, surgical technical difficulties and morbidities vary by location. Percutaneous radiofrequency ablation (RFA) therapy guided by computed tomography (CT) is now a popular treatment option for OO. This study aims to assess our single-center experience with the technique, complications, and procedure effectiveness. Materials and Methods The study included fifteen patients who were treated between 2017 and 2021. A retrospective analysis was carried out on archive images and file records. The lesions' location, nidus width, and affected area (cortical, medullary) were all recorded. The procedure and technical success, as well as postoperative complications and the need for repeat ablation, were all documented. Results A total of 20 patients, 18 men, and 2 women, were included in the study, and 12 of them were pediatric patients. The patients' mean age was 16.9±7.3 years old, and the mean nidus diameter was 7.1±8.7 mm. There were 13 cortical niduses, 2 intramedullary niduses, and 5 corticomedullary niduses. The lesions were in the femur (n=12), tibia (n=6), scapula (n=1), and vertebrae (n=1). Two recurrences (10%) were observed in our patients during the follow-up. Patient with a femoral OO, the pain started again 12 weeks after the procedure and we performed additional RFA. The patient with vertebral OO had fewer symptoms and full recovery was not achieved. Therefore, the vertebral OO was ablated again 4 months later, and clinical success was achieved. One patient had a minor burn at the entry site that went away on its own after a short period of time. Except for the patient who was scheduled for a repeat RFA, no recurrence has been observed so far. The primary and secondary success rates are, respectively, 90% (18/20) and 100% (20/20). Conclusion RFA has a high success rate in treating OO. The procedure failure and recurrence rates are low. There are possibilities for posttreatment pain relief, early discharge, and a quick return to daily life. For inappropriate lesion localization, the RFA process replaces surgical treatment. The procedure-related complication rate is low. On the other hand, the burn during the procedure can be a serious problem.

Advantages and disadvantages of methods of visualization in the surgical treatment of osteoid osteoma in children

Advantages and disadvantages of methods of visualization in the surgical treatment of osteoid osteoma in children

Meta-analysis of application of minimally-invasive ablation methods and classical surgical approach in osteoid osteoma and osteoblastoma

Abstract Osteoblastoma and osteoid osteoma are rare benign bone tumours, sometimes considered variations of the same pathologic process. However, they differ in location, incidence, age group, and size. The gold standard treatment is surgical excision for osteoblastoma and radiofrequency ablation for both. Minimally invasive techniques, including radiofrequency ablation, microwave ablations, cryoablation, ultrasound ablation, and laser ablation, are increasingly used. This meta-analysis aimed to review current treatments, focusing on minimally invasive methods versus traditional surgical excision. A data comparison of 17 original articles from the PubMed database (2014-2024) was conducted, examining treatment methods, patient numbers, success rates, pre/post-operative pain scores, and complication rates. New ablation methods achieve similar clinical results to traditional surgery for treating osteoid osteoma and osteoblastoma while minimizing invasiveness. Most procedures have technical success rates near 100%. Both invasive and non-invasive methods significantly reduce preoperative pain. Classical surgery has higher minor complication rates compared to minimally invasive treatments. Among ablation techniques, magnetic resonance guided focused ultrasound surgery is the least invasive, avoiding radiation and antibiotic-related complications. However, in ablation methods caution is needed to prevent thermal damage to nearby joints and nerves. Protective methods, such as skin protection, hydrodissection, gas dissection, and intraoperative neurostimulation, are recommended. New ablation methods provide less invasive alternatives to surgery, with high clinical and technical success rates and lower complication rates. Among these, magnetic resonance guided focused ultrasound surgery is the least invasive and most promising, though more clinical data is needed due to its recent development.

Association between surgical results and recurrence in benign and intermediate osteogenic spine tumors – osteoid osteomas and osteoblastomas

Association between surgical results and recurrence in benign and intermediate osteogenic spine tumors – osteoid osteomas and osteoblastomas

Elongated morphology of osteoid osteoma is associated with radiofrequency ablation failure in children.

To compare the frequency of elongated morphology of osteoid osteoma (OO) in children compared to adolescents and to determine if this elongated morphology is associated with radiofrequency ablation treatment failure. Retrospective review of first-time CT-guided radiofrequency ablation performed for presumed OO in patients < 21years old between 1990 and 2023. Children were considered 0 to 10years old, and adolescents were considered 11 to 20years old. Treatment failure was considered symptomatic recurrence requiring follow-up intervention. The largest tumor dimensions in three orthogonal planes were measured using multiplanar reformatted technology. Maximum tumor dimension, tumor volume, and eccentricity index were calculated. Elongated morphology criteria were (a) largest dimension > 10mm and (b) eccentricity index ≥ 3. Lesion locations were recorded. Statistical analyses included the chi-square test, Fisher's exact test, nonparametric Wilcoxon rank-sum test, receiver operating characteristic analysis, and Spearman's nonparametric rank correlation. Of 366 included patients (median 15years, IQR 11-18years, 254 male), there were 86 (23.5%) children, 280 (76.5%) adolescents, and 24 (6.6%) cases of treatment failure. Elongated morphology was more common in children (19.7%) than adolescents (8.6%) (p = 0.004) and associated with younger age (p = 0.009). Elongated morphology was associated with treatment failure in children (p = 0.045) but not adolescents (p > .99) or all patients (p = 0.17). Treatment failure was not associated with age, largest dimension, eccentricity index, volume, or location. Elongated morphology of OO is associated with younger age and radiofrequency ablation treatment failure in children. Identifying this morphology may assist with counseling and treatment planning.

Ribbing disease of the femur: a rare entity.

Ribbing disease is a rare benign bone dysplasia characterized by progressive cortical thickening of the diaphyses of long bones in adult patients. The literature provides limited insight into its natural radiological progression and anatomical distribution. Single-bone involvement is particularly uncommon, with prior cases exclusively affecting the tibia. This case report outlines the unique presentation of Ribbing disease in a 20-year-old male, localized to the left femur. The patient's history revealed intermittent left thigh pain persisting for more than 2 years, with no identifiable triggers or relief factors. Early radiographic imaging revealed no significant abnormalities, but subsequent imaging, conducted 1 year after the initial presentation, revealed focal fusiform widening and cortical thickening of the mid-diaphysis of the left femur. MRI further revealed circumferential cortical thickening with bone marrow edema, corroborated by CT, which revealed cortical thickening with near-complete obliteration of the intramedullary cavity. The patient was managed with nonsteroidal anti-inflammatory drugs and activity modifications. Misinterpretation of the radiographic findings of the osteoid osteoma led the patient to undergo radiofrequency ablation. This case highlights the challenges in diagnosing Ribbing disease and emphasizes the importance of considering it in the differential diagnosis of chronic limb pain. Continued reporting of cases contributes to enhancing our understanding and management of this rare skeletal dysplasia.

Intra-articular Osteoid Osteomas: Imaging Manifestations and Mimics.

Osteoid osteoma (OO) is the third most prevalent benign bone neoplasm in children. Although it predominantly affects the diaphysis of long bones, OO can assume an intra-articular location in the epiphysis or the intracapsular portions of bones. The most common location of intra-articular OO is the hip joint. The presentation of intra-articular OOs often poses a diagnostic enigma, both from clinical and radiologic perspectives. Initial symptoms are often vague and nonspecific, characterized by joint pain, stiffness, and limited range of motion, which frequently contributes to a delayed diagnosis. Radiographic findings range from normal to a subtle sclerotic focus, which may or may not have a lucent nidus. In contrast to their extra-articular counterparts, intra-articular lesions have distinct features at MRI, including synovitis, joint effusion, and bone marrow edema-like signal intensity. While CT remains the standard for identifying the nidus, even CT may be inadequate in visualizing it in some cases, necessitating the use of bone scintigraphy or fluorine 18-labeled sodium fluoride PET/CT for definitive diagnosis. Radiologists frequently play a pivotal role in suggesting this diagnosis. However, familiarity with the unique imaging attributes of intra-articular OO is key to this endeavor. Awareness of these distinctive imaging findings of intra-articular OO is crucial for avoiding diagnostic delay, ensuring timely intervention, and preventing unnecessary procedures or surgeries resulting from a misdiagnosis. The authors highlight and illustrate the different manifestations of intra-articular OO as compared with the more common extra-articular lesions with respect to clinical presentation and imaging findings. ©RSNA, 2024 Supplemental material is available for this article.

Percutaneous radiofrequency ablation of osteoid osteoma: results from 9 years of experience in a third-level center.

Osteoid osteoma is a benign bone tumor that accounts for roughly 2-3% of primary bone tumors and up to 10-12% of benigns bone neoplasms. It is most commonly seen in young adults, and shows male predominance. Over the last years, minimally invasive thermal ablation techniques such as radiofrequency ablation have gained popularity over classical surgery. In this study we evaluate results and complications of CT guided osteoid osteoma radiofrequency ablation. In this retrospective cohort study all patients that were diagnosed with osteoid osteoma and treated using radiofrequency ablation between January 2014 and December 2022 were included. Pain was assessed using Visual Analog Scale (VAS) pre and post procedure. Technical success was established as positioning of the radiofrequency electrode in the nidus. Primary clinical success was defined as absence of pain after one radiofrequency session. All patients that required a second radiofrequency ablation were included in the overall clinical success group. During the studied period, 61 osteoid osteoma radiofrequency ablations were performed. Fiftyseven of them were included in this study, 32 were men and 25 female. Pre procedure median pain was 9 according to VAS score. Only 23 patients were treated as outpatient, the rest stayed in hospital for 24 hours. Median follow up time was 21,7 months (SD 8,3). Biopsy was performed in 52 patients. Technical success was accomplished in 57 patients (100%). Primary clinical success was 80,7% (46 patients). Those who continued with pain or had recurrence after a symptoms free period (11 patients), were treated with a second radiofrequency ablation, achieving an overall success rate of 94,7%. Only one patient suffered a minor complication (1,7%). CT guided osteoid osteoma radiofrequency ablation is a safe, effective and low complication rate procedure, that can be performed on an outpatient basis. We believe it should be considered as a first line treatment option for osteoid osteoma.

Metachronous osteoid osteoma in adjacent proximal phalanges: a case report and literature review

Metachronous osteoid osteoma in adjacent proximal phalanges: a case report and literature review

The Effectiveness of Radiofrequency Thermal Ablation in the Treatment of Patients with Osteoid Osteomas of the Spine

Osteoid osteoma is a rare benign osteogenic bone tumor without malignant potential causing severe night pain relieved by nonsteroidal anti-inflammatory drugs. Pain associated with osteoid osteoma of the spine cannot be treated conservatively and requires surgical approach. Types of surgical treatment include intralesional curettage, marginal resection, or en bloc tumor resection. However, absence of clear intraoperative visualization of the lesion often leads to excessive resection of vertebral structures requiring additional bone reconstruction and fixation with metal structures. In some cases, due to incorrect choice of resection area and segment level, repeat surgeries are performed causing secondary spinal deformations, worsening patient’s condition, and increasing economic expenditures. Currently, minimally invasive methods of transcutaneous treatment of osteoid osteomas such as interstitial laser ablation, cryotherapy, and radiofrequency thermal ablation are becoming more prominent.Aim. To evaluate the effectiveness of radiofrequency thermal ablation treatment in patients with osteoid osteoma.Materials and methods. The prospective study included 12 patients with osteoid osteoma of the spine. Their quality of life was evaluated using the Short Form-36 (SF-36) questionnaire prior to radiofrequency thermal ablation and 30, 90 and 180 days after. At the first visit and during observation, pain syndrome intensity was measured using the Visual Analog Scale (VAS) and R.G. Watkins scale for objective evaluation of pain syndrome per number of analgesics administrations.Results. Follow-up duration varied between 12 and 36 months. In all clinical cases, general, physical, and psychological health improved 2–3-fold. Pain intensity at day 1 after radiofrequency thermal ablation compared to mean pain intensity during the day prior to the procedure was significantly lower (р = 0.05). At the final examination, none of the patients had pain (pain syndrome intensity 0 per VAS); all patients had subjective satisfaction level of 100 %. Analgesics (nonsteroidal anti-inflammatory drugs and paracetamol) were administered on request for 8 ± 2.34 days after the procedure.Conclusion. Based on literature data and our own experience of diagnosis and surgical treatment of osteoid osteoma of the spine, we conclude that in cases of small lesions (&lt;2 cm) in hard to access locations, computed tomography-controlled radiofrequency thermal ablation allows to perform surgical intervention safely, effectively and with minimal number of complications.

Diagnostic Challenges of Osteoid Osteoma of the Femoral Neck in an Adolescent: A Case Report

Non-traumatic hip pain in adolescents presents a significant diagnostic challenge. We report the case of a 19-year-old female patient treated for idiopathic juvenile osteoporosis with zoledronic acid, presenting with chronic inflammatory right hip pain that responded well to NSAIDs, associated with back and buttock pain. The inflammatory markers, including CRP and ESR, were negative. The pelvic radiography was normal, though thoracolumbar spine radiography revealed scoliosis. Consequently, MRI of the sacroiliac joints was performed to search for sacroiliitis but revealed a 5 mm nidus with reactive sclerosis, suggestive of an osteoid osteoma. The natural progression of the patient's pain showed spontaneous regression within one year.

Epidemiology of bone tumors in children and adolescents: a retrospective study of 266 patients in the south of Tunisia.

Although bone tumors (BT) are relatively uncommon among the human neoplasm, they constitute the most frequent tumors in children and adolescents (CAA). Little information is available about the epidemiologic features of BT in CAA. We aimed to present and discuss epidemiological characteristics of BT in CAA in southern Tunisia, regarding the different histological types. This is a retrospective study including cases of BT in CAA collected in the pathology department at the Habib Bourguiba university hospital over a period of 15 years (2006- 2020). A total of 266 BT was diagnosed in our institution (42,7% among all BT in Southern Tunisia) divided into 200 benign bone tumors (BBT) (75,2%) and 66 malignant bone tumors (MBT) (24,8%). The mean age for all BT was 14,2 years (3-20 years) with male predominance (sex ratio: 1,48). The most common tumor was osteochondroma (42.2%) followed by osteosarcoma (14.6%) and Ewing sarcoma (6.4%). For BBT, the most affected age group was the 16 to 20 year - old - group (50,7%) with a male predominance (59.8%) and a predilection for lower limb (66.8%) then the upper limb (16,8%). Osteochondroma was the most common histological type (56.5%) followed by aneuvrysmal cyst (8,5%) and osteoid osteoma (6,5%). For MBT, the mean age was 12,5 years (5-20 years) and the most affected age group was the 11 to 15 year -old -group (59%). Boys were more affected (60.6%), with a preference for the lower limb (57%) followed by the pelvis (15,6%). Osteosarcoma was the most common MBT (60%) followed by Ewing sarcoma (24%). Given their rarity and heterogeneity, the diagnosis of BT is particular in CAA and requires a multidisciplinary approach. The reporting of epidemiological studies remains essential in order to expand our knowledge regarding these uncommon tumors.