Spinal osteoid osteoma: Surgical resection and review of literature

Abstract

Background: Osteoid osteoma (OO) is a rare benign tumor of the spine that involves the posterior elements with 75% tumors involving the neural arch. The common presenting symptoms include back pain, deformity like scoliosis, and rarely radiculopathy.

Methods: From 2011 to 2017, we evaluated cases of OO managed by posterior surgical resection while also reviewing the appropriate literature.

Results: We assessed five patients (three males and two females) averaging 36.60 years of age diagnosed with spinal OOs. Two involved the lumbar posterior elements, two were thoracic, and one was in the C3 lateral mass. All patients underwent histopathological confirmation of OO. They were managed by posterior surgical resection with/without stabilization. No lesions recurred over the minimum follow-up period of 24 months.

Conclusion: Surgical excision is the optimal treatment modality for treating spinal OOs. The five patients in this study demonstrated good functional outcomes without recurrences. Further, the literature confirms that the optimal approach to these tumors is complete surgical excision with/without radiofrequency ablation.

Keywords: Gross total resection; Osteoid osteoma; Posterior elements; Radiofrequency ablation; Resection; Spinal involvement; Tumor.

Figure 1:

(a) Preoperative sagittal and axial T2-weighted MRI showing osteoid osteoma at L4 pedicle with pars lysis. (b) Sagittal and axial CT scan showing osteoid osteoma involving L4 pedicle with lysis of pars (c). (c) Postoperative X-ray showing bilateral pedicle screw fixation with the left pars bone grafting.

Figure 2:

(a) Preoperative CT scan (sagittal/axial/coronal) showing osteoid osteoma involving the right D9 pedicle and lamina. (b) Postoperative X-ray showing pedicle screw stabilization at D8 and D10 level.

Figure 3:

(a) MRI showing lesion involving C3 lateral mass on the left side. (b) Postoperative AP and lateral X-ray following curettage and excision without stabilization for C3 osteoid osteoma.

Figure 4:

(a) Sagittal and axial CT scan demonstrating osteoid osteoma involving left L5 pedicle and lamina. (b) Sagittal and axial T2-weighted MRI showing lesion involving left L5 pedicle and lamina. (c) Postoperative CT scan demonstrating complete excision of lesion. (d) Postoperative AP and lateral X-ray showing pedicle screw fixation (L5, S1).

Figure 5:

(a) Sagittal MRI showing lesion involving the D10-D11 facet. (b) Postoperative CT scan following excision of lesion and fixation at D9 and D11 vertebral level.