Orthopedic Oncology cases osteoid osteoma1
A 14-year-old female presents to your office complaining of pain in her lower leg. She reports progression of pain over the past 3 months, especially at night. She has good temporary relief with ibuprofen but limits her intake due to GI upset. CT scan is shown in Figure 8–46.
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Figure 8–46
All of the following statements are true of this lesion except:
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The lesion is always painful and in the epiphysis of a child
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They are most commonly diaphyseal and intracortical
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Spinal lesions can cause a painful scoliosis; lesion is on concave side of curve
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Bone scan often shows the “double density” sign
Discussion
The correct answer is (A). Osteoid osteomas are small, painful bone lesions that are usually intracortical. They are hot on bone scan, showing “double density sign” caused by diffuse uptake in the surrounding reactive region and higher uptake by the central nidus. When they develop in the spine, they can cause a painful scoliosis with the lesion on the concave side of the curvature; the scoliosis usually resolves without further treatment once the osteoid osteoma is treated. Chondroblastoma is the most common painful lesion found in the epiphysis of a child, not osteoid osteoma.
The patient is resistant to conservative management, as she cannot tolerate NSAIDs and is considerably bothered by the pain. What treatment would you recommend?
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Curettage and bone graft
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Wide resection and intercalary graft reconstruction
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Marginal excision and prophylactic plating
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Radiofrequency ablation
Discussion
The correct answer is (D). The preferred treatment is percutaneous radiofrequency ablation, typically performed by an interventional or musculoskeletal radiologist. Open curettage is recommended for lesions that present a high risk of complication with radiofrequency ablation, recurrent lesions, or in situations where the diagnosis is uncertain.
Objectives: Did you learn...?
To recognize clinical and radiographic features of osteoid osteoma? Treatment of osteoid osteoma?