Review Question - QID 2819

The radiographic findings are consistent with an osteoid osteoma. This lesion is likely an incidental finding, and not likely to be causing the patients symptoms. Continued clinical observation is the most appropriate treatment.

Considering the patient has a recent history of a water skiing accident with acute onset of back and leg pain, his symptoms possibly represent an acute muscle sprain and radiculopathy. Of note, the lesion is on the left while his radicular symptoms are on the right. Therefore, the first line of treatment should be clinical observation.

Volkmer et al discuss the use of radiofrequency ablation for lesions such as osteoid osteomas. They report that osteoid osteomas are usually a self-limited phenomenon and the first line of treatment should be observation and NSAID administration. They report the relative indications for radiofrequency ablation of osteoid osteomas are when medical management fails, or the lesion is periarticular placing the patient at increased risk of cartilage injury and premature degenerative disease.

Image A and B is a CT scan showing a nidus surrounded by sclerotic bone involving the neural arch of L5.

Incorrect Answers:
Answer 1: An MRI is not yet indicated for his radicular symptoms as they have only been present for two weeks and he had no neurologic deficits.
Answer 2,3 &4: The ostoid osteoma is not likely causing the patients symptoms, so treating it would not be appropriate.