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Technetium bone scan, MRI and CT. A; Technetium bone scan was useful in localizing the lesion. B, C; MRI revealed an intramedullary lesion, with isointense low signal on T1-weighted images and isointense high signal on T2-weighted images. D; Intense reactive sclerosis surrounding the nidus was seen on CT images.
Source publication
Osteoid osteoma of the spine is a relatively rare bone-forming tumor. Pain that is worse at night and relieved by aspirin and muscle contracture are the most characteristic symptoms of spinal osteoid osteoma. Although radicular pain occasionally occurs in spinal osteoid osteoma, spinal cord and nerve root compression is absent in most cases. Althou...
Contexts in source publication
Context 1
... radiographic examination revealed few distinct abnormalities in the lumbosacral spine. Radio- nuclide bone scan, which revealed increased uptake of isotope in the S1 lamina on the left side, was useful in localizing the lesion ( Figure 1A). Magnetic resonance imaging (MRI) revealed an intramedullary lesion, with isointense low signal on T1-weighted images and isoin- tense high signal on T2-weighted images ( Figure 1B, C). ...Context 2
... nuclide bone scan, which revealed increased uptake of isotope in the S1 lamina on the left side, was useful in localizing the lesion ( Figure 1A). Magnetic resonance imaging (MRI) revealed an intramedullary lesion, with isointense low signal on T1-weighted images and isoin- tense high signal on T2-weighted images ( Figure 1B, C). The lesion was enhanced by gadolinium (Gd-DTPA). ...Citations
... So far, no case of neurological deficit has been reported in the literature due to spinal osteoid osteoma [13]. Though spinal osteoid osteoma occurs close to neurological structures, deficit rarely occurs due to its small size [14]. Radiculopathy has been reported due to reactive inflammation caused by tumour [15]. ...
Osteoid osteomas of spine are not uncommon and majority of which occurs in posterior elements of lumbar spine. Management of such lesions in spine ranges from open en bloc excision to percutaneous radiofrequency ablation. In this series, we have managed three cases of osteoid osteomas of spine, each managed differently from conventional open technique to minimally invasive method. All three cases underwent appropriate radiological investigations and followed by surgical excision of the lesion and histopathological analysis post-operatively. First case was managed with open excision of the lesion with conventional unilateral pedicle screw stabilisation. Second case, who underwent open excision of the lesion developed recurrence which was managed by re-excision without any further complications. Last case underwent microendoscopic quadrant tubular excision of the tumour with unilateral MISS with pedicle screws. The technique of Microendoscopic quadrant tubular excision of posterior element benign tumour had advantages of small skin incision, less bleeding, clear macroscopic visualisation of the small tumour (enables complete excision of the nidus thus decreasing the recurrence), early mobilisation and shorter hospitalization with effective and complete excision of the tumour better than open method. Further, histological evidence of tumour will be available. The complete excision of nidus using microendoscopic tubular retractors with unilateral fixation in young age gives encouraging results. This case series is followed by review of literature highlighting the role of COX-2 inhibitors in osteoid osteoma, cause for scoliosis and neurological deficit in osteoid osteoma and management of osteoid osteomas of spine. Keywords: Tumor, Osteoid osteoma, Minimally invasive, Dorsolumbar spine, Excision biopsy
... While axial pain is the rule, radicular involvement with clearcut radiculopathy in OOs are much rarer; in most such cases compression by the tumor is advocated, while to our knowledge only two non-compressive cases have been described to date: the Authors documented intense periradicular infiltration by lymphocytes and plasma cell at histology, in a T 11 OO [11]. Although lacking histological confirmation a similar mechanism can be advocated in our patient based on prominent MRI inflammatory findings. ...
... The diagnosis of spine OOs is challenging and often delayed due to a specific symptoms and the small size of the lesion which can be easily missed not only at plain X-rays in classic projections but also at CT if appropriate slice thickness, orientation or multiplanar reconstructions are not carried out. While radionuclide scanning has been indicated as a valuable localizing tool [5,7,11], MRI is considered the stateof-the-art investigation since the redundant inflammatory changes in soft tissues and bone oedema associated to OOs are best highlighted. The nidus of an OO is intermediate to low signal intensity on T1-w images while shows variable signal on T2-weighted sequences depending upon the amount of mineralized matrix within the nidus. ...
Cervical radiculopathy is a common clinical condition with an annual incidence of 85/10,000. Refractory cases with positive disco-vertebral imaging findings are routinely referred to the Neurosurgeon for evaluation and treatment. In the absence of a clearcut compressive etiology, other rarer but surgically curable causes must be considered before recommending conservative management. We discuss the case of an otherwise active, healthy patient with an invalidating, refractory, relapsing nuchal pain and cervical radiculopathy. Only careful and state-of-the-art neuroimaging led to the correct diagnosis: an osteoid osteoma of the right C6 lamina was diagnosed and microsurgically resected allowing complete recovery and cure. The clinical features of these rare tumors in this unusual location are reviewed. The case is relevant for multifold reasons: it draws attention to rare conditions which can mimic radicular compression; emphasizes the need for a careful evaluation and appreciation of specific clinical symptoms and signs associated with non-compressive radiculopathies; prompts planning of a state of the art imaging workup, in order to rule out such an elusive tumor. All these measures minimize the risk of overlooking the present and other rare pathologies, sparing patients a long path of time-consuming, frustrating and cost-ineffective studies and treatment modalities.
... It is frequently localized to the long bones of the lower extremity. Spinal OO is rare (10%) (5), and present more of- ten in the posterior spinal elements. The region is most com- ...
Background. We report a misdagnosed pediatric case of osteoid osteoma in sacrococcygeal region. Previously it was said by general surgery that the source of pain was the pilonidal sinus and was therefore operated. A CT scan was taken and showed that the patient had sacro-coccygeal osteoid osteoma which nidus was very close the right S4 spinal root. The lesion was therefore marked on CT scans and resected by performing an open surgery. Methods. This report reviewed the patient's medical records , imaging studies, treatment, and related literature. Results. Our patient, who had a continuous pain for 2 years, applied to our orthopedic clinic due to aches and pain at sacrococcygeal region. The characteristic clinical symptom was nocturnal pain especially night that decreases or resolves completely with salicylates. Previously it was said by general surgery that the source of pain was the pilonidal sinus and was therefore operated. Our patient who had no decrease pain after surgery was advised to use salicylate which resulted in dramatic responses. A CT scan was taken and showed that our patient had sacrococcygeal osteoid osteoma which nidus was very close the right S4 spinal root. The lesion was therefore marked on CT scans and resected by performing a mini-open surgery. Conclusion. Osteoid osteoma is a benign tumor of bone, especially in children and young adults. Often seen in the lower bones of the lower extremity, the sacral vertebra is very rare and causes severe localized pain at night. When such a chart is encountered in children and young adults, osteoid osteoma should be considered carefully in the differential diagnosis.
... It is frequently localized to the long bones of the lower extremity. Spinal OO is rare (10%) (5), and present more of- ten in the posterior spinal elements. The region is most com- ...
Background. We report a misdagnosed pediatric case of osteoid osteoma in sacrococcygeal region. Previously it was said by general surgery that the source of pain was the pilonidal sinus and was therefore operated. A CT scan was taken and showed that the patient had sacro-coccygeal osteoid osteoma which nidus was very close the right S4 spinal root. The lesion was therefore marked on CT scans and resected by performing an open surgery. Methods. This report reviewed the patient's medical records , imaging studies, treatment, and related literature. Results. Our patient, who had a continuous pain for 2 years, applied to our orthopedic clinic due to aches and pain at sacrococcygeal region. The characteristic clinical symptom was nocturnal pain especially night that decreases or resolves completely with salicylates. Previously it was said by general surgery that the source of pain was the pilonidal sinus and was therefore operated. Our patient who had no decrease pain after surgery was advised to use salicylate which resulted in dramatic responses. A CT scan was taken and showed that our patient had sacrococcygeal osteoid osteoma which nidus was very close the right S4 spinal root. The lesion was therefore marked on CT scans and resected by performing a mini-open surgery. Conclusion. Osteoid osteoma is a benign tumor of bone, especially in children and young adults. Often seen in the lower bones of the lower extremity, the sacral vertebra is very rare and causes severe localized pain at night. When such a chart is encountered in children and young adults, osteoid osteoma should be considered carefully in the differential diagnosis.
... The one reason for failing to detect the extensive edema of osteoid osteoma at the initial MRI was that the axial assessment was only performed at the disc level, not at the middle vertebral level, because the axial MRI views were used to assess the lumbar discs. A previous case report indicated that osteoid osteoma in the lumbar spine could cause radiculopathy and low back pain because of the inflammation caused by the osteoid osteoma [19]. In the present case, lumbar disc herniation was not a differential diagnosis, because of the lack of any radiculopathy and no findings of herniation on MRI. ...
Patient: Male, 18
Final Diagnosis: Osteoid osteoma
Symptoms: Low back pain
Medication: —
Clinical Procedure: Operation
Specialty: Orthopedics and Traumatology
Objective
Rare disease
Background
Osteoid osteomas are benign bone-forming tumors characterized by local inflammation and pain. They are also characterized by a small osteolytic lesion (nidus). Spondylolysis is a defect of the pars interarticularis, which may lead to stress fractures, and is a common cause of low back pain in adolescence. Osteoid osteoma occurs predominantly in the posterior elements of the spine. Magnetic resonance imaging (MRI) signal abnormality suggesting bone marrow edema is a common finding in osteoid osteoma and early-stage spondylolysis without prominent defect.
Case Report
An 18-year-old male was suffering from low back pain. He was diagnosed with lumbar spondylolysis on initial MRI and computed tomography (CT). Subsequent thin-slice CT demonstrated a nidus at the pars interarticularis, and variously-sliced MRI could detect widespread bone marrow edema. On the diagnosis of an osteoid osteoma, the nidus and surrounding osteosclerosis were resected. The patient’s pain disappeared after surgery.
Conclusions
Osteoid osteoma in the pars interarticularis can be difficult to diagnosis, because MRI and CT findings for osteoid osteoma at the pars interarticularis are similar to those of the lumbar spondylolysis. The possibility of osteoid osteoma should be kept in mind when examining adolescents with low back pain.
... Osteoid osteoma was firstly described by Jaffe in 1935. Osteoid osteomas are benign, painful, small sized osteogenic tumors of young patients [3][4][5]. Typically, long bones are affected, and it is primarily located within the cortex [3,4]. It is composed of a small "nidus (lytic lesion)" measuring from a few millimeters to 1.5-2 cm, which exhibits various portions of calcification and is surrounded by reactive sclerosis and periostal reaction [4,6]. ...
... It is composed of a small "nidus (lytic lesion)" measuring from a few millimeters to 1.5-2 cm, which exhibits various portions of calcification and is surrounded by reactive sclerosis and periostal reaction [4,6]. Histopathologically, osteoid osteoma is composed of anastomosing bony trabeculae of various widths and bony trabecule is rimmed by a single layer of osteoblasts, sclerotic bone and vascular osteoid tissue [4,5,7]. Cartilage tissue and mitotic figures are usually absent [4,7]. ...
... Also, the case showed that BMP6 and S100 were useful for revealing presence of osteoid matrix and differentiation [13,14]. Osteoid osteoma was evaluated before only in a dog to best of our knowledge [5]. But, immunohistocehmistry has not been used for describing in such kind of cases. ...
Osteoid osteoma and osteoblastoma are uncommon benign bone tumors which originate from osteoblasts in animals. Both tumors have similar characteristics. Osteoid osteoma is well described in humans, but there known to be only two cases in domestic animal species. Differentiating the diagnosis of osteoid osteoma from osteoblastoma by using immunohistochemistry was aimed in this study. A 12-year-old mix breed female dog was brought to the clinic with complaints of swelling in proximal forelimb and progressive loss of motion. Animal was died during surgery. In necropsy, tissue samples were taken from the mass and fixed in %10 formalin. Samples were stained with hematoxylin and eosin, Masson’s trichrome and Alizarin Red S. For revealing of cell differentiation, ABC-P method was applicated to adhesive section by using BMP6, S100, vimentin ve p53 markers. Macroscopically, proximal humerus was swollen. Cut section was generally lytic within bone residues. Soft tissue was haemorrhagic and edematouse. Microscopically, osteoblasts and hypervascular nidus were surrounded by large sclerotic and mineralized bone tissue. Large lytic areas were also observed. Masson’s trichrome revealed sclerosis and Alizarin Red S revealed osteoid matrix. Immunohistochemically, BMP6 was moderately reacted in osteoid matrix and S100 was moderately reacted with nerve fibers in nidus. Vimentin had strictly positive reaction in fibrocytes. P53 was negative in osteoblasts.
In conclusion, this case is the third reported in domestic animals and the second in dogs. Also osteoid osteoma is evaluated for the first time by immunohistochemistry in animals.
... In the series by Ozaki et al. (24) 2 of 9 cases and in the series by Raskas et al. (25) 7 of 11 patients had radicular pain. Spinal cord and nerve root compression is absent in most cases with radicular pain (26). Radicular pain may be related to inflammation around the nerve root. ...
... Radicular pain may be related to inflammation around the nerve root. Zenmyo et al. (26) reported two cases with radicular pain due to peritumoral inflammation that was histologically verified around the nerve root. Large amounts of prostaglandin E2 and prostacyclin released from the nidus may be related to the isolated root irritation (21). ...
... After them, this condition was mentioned in detail in only case reports (26,34,(39)(40)(41)(42). Although bony and soft tissue changes are relatively frequent in these cases, unfortunately, large series of spinal OO in literature were mainly interested in treatment of lesions and they did not mention MRI findings in detail, especially soft tissue changes (5-10, 15). ...
Context:
Spinal osteoid osteoma (OO) is an infrequent tumor and due to both its smallness and complex anatomy of the spine diagnosis is challenging. In addition, associated undefined soft tissue changes on magnetic resonance imaging (MRI) frequently cause misdiagnosis.
Evidence Acquisition:
PubMed database was searched for “spinal osteoid osteoma” and larger clinical series related to clinical pictures, diagnosis or treatment modalities, and also case reports with especially soft tissue changes and related to special treatment modalities were introduced to the study. It was aimed at to make conscious practitioners of clinical and diagnostic characteristics of spinal OOs.
Results:
Spinal OOs constitute about 10% of OOs and the most of the tumors are seen in adolescents or young adults. The most frequent clinical picture is painful scoliosis or torticollis according to the level of the tumor. On MRI that is the most frequently performed imaging modality in the patients with painful scoliosis, undefined extensive bone and soft tissue changes is quite frequent. Clinicians must be aware from these findings and they must suspect and investigate the patients with bone scintigraphy and thin sectioned computerized tomography that both of them together can show presence of the lesion and provide to determine exact location of the lesion. Despite the increasing number of the studies using percutaneous ablation techniques, standard treatment of spinal OOs is still intralesional excision. Surgical excision usually provides immediate pain relief, and recurrence is not frequent.
Conclusions:
Diffuse paravertebral muscle and soft tissue involvement having resemblance to myositis is not quite rare in the patients with spinal OO. This may be the sole finding on MRI and it must be alert for the clinicians to look for small OO nidus by bone scintigraphy or thin sectioned CT scan.
... Although osteoid osteoma often develops close to the spinal cord and nerve roots, due to the small size of the lesion, neurologic impairment rarely occurs [1,11,12]. Only one report detailed radiculopathy without nerve root compression from osteoid osteoma [12]. ...
... Although osteoid osteoma often develops close to the spinal cord and nerve roots, due to the small size of the lesion, neurologic impairment rarely occurs [1,11,12]. Only one report detailed radiculopathy without nerve root compression from osteoid osteoma [12]. Neurological symptoms may be induced by tumorous inflammation even without nerve root compression. ...
We present a rare case of a patient who underwent complete microendoscopic excision of an osteoid osteoma, which induced radiculopathy without nerve root compression. A 20-year-old man presented severe right groin pain that was temporarily relieved by nonsteroidal anti-inflammatory drugs. A computed tomography (CT) scan showed typical features of a nidus located in the inferior cortex of the right L3 pedicle. We performed surgery using a posterior microendoscopic approach. We drilled vertically along the line of the cortex of the caudal pedicle using a high-speed drill. After identifying the tumor, en bloc resection of the nidus was achieved. Immediately after surgery, pain in the right groin disappeared. A CT scan showed that most of the right L3 pedicle remained. This minimally invasive technique preserves spinal structures, including the facet and pedicle, and is a viable option for the treatment of spinal osteoid osteomas located close to vital structures.
... Pain of an osteoblastoma, unlike that of an osteiod osteoma, does not have diurnal variation and is not relieved by nonsteroidal anti-inflammatory drugs [2]. Radiculopathy and neurological deficit occurs mostly in an osteoblastoma with rare occurrence in an osteiod osteoma [7]. In laboratory studies, alkaline phosphatase may be slightly raised. ...
Osteoblastomas are bone forming lesions arising mainly from posterior elements of the vertebra. They are commonly encountered in the cervical and lumbar regions. We present a case of a thoracic osteoblastoma which is extra osseous and is not communicating with any part of the vertebra present intraforaminally. This is a rare presentation of an osteoblastoma. Imaging studies do not accurately diagnose the osteiod lesion. The size of the lesion and cortical erosion seen on the computed tomography scan help in differentiating the osteoid osteoma and osteoblastoma, but they are less sensitive and specific. Thus a histopathology is the investigation of choice to diagnose the osteoblastoma. Early and adequate removal of mass prevents malignant transformation, metastasis, and recurrence. In our case we excised the pars interarticularis unilaterally, removed the osteoid mass intact, and performed unilateral instrumented fusion. There was no recurrence and solid fusion was seen at 3 years follow up.
... Thoracic radiculopathy is a rare condition with few reports on appropriate management (1). Factors causing thoracic radiculopathy are mainly disc herniation, spondylosis, tumor, cysts, and fracture of vertebral body (2)(3)(4)(5)(6)(7)(8). Thoracic ossification of the ligamentum flavum (OLF) has been widely recognized as a main cause of thoracic myelopathy in Asia, especially in Japan (9). ...
Abstract Thoracic ossification of the ligamentum flavum (OLF) has been widely recognized as a main cause of thoracic myelopathy in Asia, particularly in Japan. However, thoracic OLF rarely causes radiculopathy. We report a rare case of thoracic radiculopathy caused by OLF. A 67-year-old male presented with a chief complaint of back pain radiating to the right of the abdomen. Neurological examination revealed mild sensory deficit at the right side of the abdomen at the T9-10 level. Magnetic resonance imaging and computed tomography demonstrated OLF at the right T9-10 level. Thoracic radiculopathy caused by OLF was suspected. Because conservative treatment was not effective to this lesion, surgical intervention was performed, and the pain disappeared immediately after the operation. Thoracic OLF rarely causes radiculopathy, but it should be considered as a differential diagnosis of thoracic radicular pain. When conservative treatment is not effective in this lesion, surgical treatment should be considered.
