Clinical Findings and Results of Surgical Resection of Thoracolumbar Osteoid Osteoma

Abstract

Study DesignDescriptive, cases series study.PurposeTo evaluate clinical findings and results of treatment of patients with spinal osteoid osteoma who underwent surgery.Overview of LiteratureOsteoid osteoma is a benign tumor with spinal involvement rate of about 10%. It is manifested during adolescence with symptoms such as painful scoliosis. To treat the problem, operation on the patients and excising the nidus are suggested.MethodsThis descriptive study was conducted on 11 patients with spinal osteoid osteoma at our orthopedic educational center. All patients were treated through open surgery and nidus curettage. All samples were pathologically confirmed. Imaging methods (spiral computed tomography-scan) was used in preoperative planning. Scoliosis and other clinical findings were studied.ResultsThe study was conducted on 11 patients comprising 6 females (54.5%) and 5 males (45.5%) with the mean age of 14.6 years. Mean deviation of scoliosis resulting from spinal osteoid osteoma was 22.8 degrees. There was more scoliosis in the involvement of the lumbar vertebra. In comparison with adults, scoliosis was more severe in youths. There was one case of vertebra body involvement with manifestation of painful scoliosis. Due to lack of careful preoperative examination, the surgery was repeated for this case. No sign of recurrence was observed in patients who underwent open surgery and all scoliosis in the follow-up had improved.ConclusionsBased on our findings, surgical excision of spinal ostoeid osteoma was successful and complete recovery was achieved in spinal deformity in the course of follow-up. Scoliosis is often seen during adolescence and lumbar involvement is more severe.

Spinal Osteoid Osteoma Associated With Soft Tissue Changes as a Challenging Diagnosis: A Review of the Literature

“…Scoliosis resulting from spinal OO was observed to be more pronounced in lumbar vertebra involvement and was more severe in youths than in adults (6). Also, when the fourth or fifth lumbar vertebra is involved, it was generally associated with pelvic obliquity (17).…”

“…In a study from pathology laboratory of a big university hospital, only 8 out of 131 OOs were located in the spine or sacrum (6.1%) (5). Therefore, spinal OO series are usually small and largest series in literature consist of 5 to 81 cases (4)(5)(6)(7)(8)(9)(10) Osteoid osteoma usually occurs in the first 3 decades of life and 90% of the patients are younger than 25 years. However, there are a few older patients in literature (12).…”

Scoliosis secondary to lumbar osteoid osteoma

“…[4,7] However, for cases at the early stage of osteoid osteoma, they may not present with obvious pain. [8] The incidence of osteoid osteoma-related scoliosis varies from 20% to 70%, [9–11] and spinal scoliosis is mainly due to chronic muscle cramps and inflammatory reactions surrounding the tumor. [12] X-ray examination has its limitation in diagnosing osteoid osteoma as the tumor nest often locate at concave side of the apical segment; by contrast, radionuclide bone scanning has its advantage in locating the lesion.…”

“…[14,15] The misdiagnosis rate is reported to be as high as 54.5%. [9] Uehara et al [1] reported a case of misdiagnosis of osteoid osteoma at the lamina of the 10th thoracic vertebra, which they presumed to be scoliosis and planned to perform posterior correction surgery, but as the preoperative CT examination revealed manifestations of osteoid osteoma, they corrected the diagnosis.…”

Imaging of Benign Tumors of the Osseous Spine

“…Most spinal OO are located in the posterior elements of the vertebra. Stiff and painful scoliosis is the most typical presentation (20–70% of cases) [3]. Muscular spasm may result in scoliosis, which is initially non-rotational.…”