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Case 100

Osteoid Osteoma of the Spine

Back pain in a 14 year old male

Imad Azouka

Clinical History:

A 14 year old male patient repeatedly sought medical advice, complaining of dull aching pain in his left lower back. The pain was intermittent, worsening at night. The pain persisted through the last 2 years with some limitation of movement on the left side.

CT Scan Findings

1 x 0.5 cm, nidus, oval lucent focus within surrounding sclerosis is seen involving the region of neural arch of L5 vertebra body at its inferio posterior aspect showing some eccentric bony expansion. These findings are typical of Osteoid Osteoma.

Diagnosis

Osteoid Osteoma of the Spine

Discussion

The nidus may be radiolucent or may contain calcifications with variable surrounding sclerotic reaction. There may be more than one nidus in a single Osteoid Osteoma or multiple Osteoid Osteomas each with its own nidus.

Surgery is the method of choice for treatment. Radiofrequency ablation is a newer alternative. Failure of surgery may suggest incorrect diagnosis. No malignancy or metastasis has been reported.

CT Scan is very helpful in cases of Osteoid Osteoma of spine, pelvis and femoral neck.

Osteoid Osteoma is a benign osteoblastic tumor of bone, and was described in 1935 by Jaffe. Very frequently seen between the ages of 10 and 30 with male to female ratio of three to one.

The hallmark of Osteoid Osteoma is dull and localized intermittent bony aching pain which increases at night.

• 60% of Osteoid Osteoma occur in femure or tibia.
• 70% in long bones.
• 20% in hands and feet.

The vertebral column, innominate bone, skull, ribs, clavicle and scapula are uncommon sites of the disease.

The indolent nature of Osteoid Osteoma, has caused patients to seek medical attention so late with resultant delayed diagnosis and manifestations ranging from growth aberrations, skeletal deformity and muscle wasting.

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