https://upload.orthobullets.com/topic/2059/images/scoli axial.jpg
https://upload.orthobullets.com/topic/2059/images/osteoid osteoma.jpg
https://upload.orthobullets.com/topic/2059/images/oo spine.jpg
https://upload.orthobullets.com/topic/2059/images/patho scoli ap.jpg
  • Painful, usually mild scoliosis resulting from a benign bone tumor most commonly located in the posterior elements of the spine. Causes include  
    • osteoid osteomas   
      • occur in the apex of the concavity of the curve 
      • curves are typically rigid
      • can occur in the vertebral body or posterior elements
      • demonstrate same histology as osteoid osteomas in the peripheral skeleton
    • osteoblastomas     
      • larger lesion than osteoid osteoma
      • pain is usually less severe than osteoid osteoma
  • Epidemiology
    • can occur in all age groups 
  • Mechanics
    • scoliosis is thought to develop in response to painful paraspinal muscle spasms
  • Prognosis
    • outcomes good with treatment   
      • most cases of scoliosis due to osteoid osteoma will resolve after resection of tumor if 
        • performed within 15-18 months of onset of curvature
        • child is less than 11 years of age
  • Symptoms
    • back pain
      • most commonly at night
    • pain relieved by anti-inflammatories
      • less relief reported with osteoblastomas
  • Physical exam
    • posterior trunk
      • curvature of the spine
        • usually mild
    • neurological exam
      • may have neurological deficits with osteoblastoma
        • findings dependent on level of lesion 
  • Radiographs
    • AP/Lateral of spine 
      • can determine level and severity of curvature
    • findings
      • lesion is defined by cortical thickening with radiolucent nidus 
        • osteoid osteoma is less than 1 cm in diameter by definition
        • osteoblastoma is greater than 1.5 cm
  • CT scan   
    • fine cut best  for outlining lesion and determining treatment plan
  • MRI
    • good for showing proximity to neurovascular structures
    • may only show soft tissue edema and not the nidus
  • Bone scan
    • markedly increased uptake in area of lesion
  • Non-operative
    • NSAIDs, observation
      • indications
        • minimal curve
      • outcomes
        • may take up to 36 months to resolve  
        • osteoblatomas usually do not respond to NSAIDS
  • Operative
    • en bloc resection of lesion  
      • indications
        • painful, progressive scoliosis
      • outcomes
        • resolution of curve if removed with 15-18 months of onset of curve in child less than 11 years old
    • radiofrequency ablation of lesion
      • indications
        • usually not an option due to proximity of neurological structures of spine
          • case by case basis based on 3D studies (CT, MRI) 

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Questions (2)

(OBQ10.156) Which of the following statements regarding osteoid osteomas in the spine is correct? Review Topic

QID: 3244

Scoliosis caused by osteoid osteoma is typically a flexible curve




Osteoid osteomas in the spine cannot be treated by radiofrequency ablation




Spinal osteoid osteomas typically occur on the concave side of the curve




Osteoid osteomas always occur in the vertebral body of the spine




Osteoid osteomas in the spine show more malignant histological behavior than those in the extremity



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