Osteoid Osteoma

Osteoid Osteoma

DEFINITION

Osteoid osteoma is a benign tumor or lesion of the spine seen in children between 5 and 20 years old.

COMMON SYMPTOMS OF OSTEOID OSTEOMA

Children with osteoid osteoma frequently present with back pain, localized to the area of the lesion (thoracic, lumbar, or neck).  The lesion is located toward one side of the spine.  As a result, the pain is usually localized to the right or left.  This localization to one side can causescoliosis, a lateral or side-to-side curve in the back.  Some researches have stated that osteoid osteoma is the number one cause for painful scoliosis in children. The pain typically worsens at night and is usually temporarily relieved with aspirin or another non-steroidal anti-inflammatory (NSAID) medicine.

DIAGNOSING OSTEOID OSTEOMA

The lesion is very difficult to see on x-ray, which rarely shows a sclerosis (density) in the spine.  This fact may delay a diagnosis of osteoid osteoma.  If pain continues further studies, including a bone scan that will show increased activity (a hot scan) in the area of the osteoid osteoma, are warranted.  Other studies include a CAT scan through the area of the lesion, which will demonstrate the osteoid osteoma very well.  A MRI can be performed, but is less useful.  The advantage of the MRI is that it has the ability to rule out other processes such as infection or other types of tumors.

TREATMENT

The use of aspirin or other non-steroidal anti-inflammatory medications (NSAIDs) can sometimes treat the pain adequately.  In the case of no deformity such as scoliosis, this treatment can be continued until the osteoid osteoma burns out on its own.  The lesion will typically burn out and disappear at the end of skeletal maturity (between ages 14-20).  Therefore, in older children, the use of aspirin and observation may be all that is required.

In patients with scoliosis, the lesion should be removed surgically.  By doing so, the physician can prevent the scoliosis from becoming worse or fixed.  If the lesion is removed early, the scoliosis will usually improve on its own.  The surgery entails finding the lesion and removing the center of it (the nidus).  Osteoid osteomas are almost always found in the posterior aspect of the spine (the back of the spine); therefore, the surgery is approached from the back.

DEFINITION

Stenosis, defined as any type of narrowing, is narrowing of the spinal canal, nerve root canals, or intervertebral foramina (areas in which the nerve roots travel) in spinal stenosis.  The narrowing can be local (affecting only one nerve root on one side of the body), segmental (involving one specific area in the lumbar spine), or generalized (involving a large part of the lumbar spine) and can be caused by excess bone, soft tissue, or a combination of the two.  Although the term “narrowing” is quite vague, this definition is a good beginning in understanding stenosis.

The largest group of patients with stenosis have a degenerative (arthritic) etiology.  Other causes include: congenital (a patient is born with a tight spinal canal, such as in certain dwarfing syndromes like Achondroplasia), developmental (forms during growth and development), trauma (when a fracture pushes bone or soft tissue into the spinal canal or neural foramen such as in a burst fracture), or tumor.

WHY DOES STENOSIS OCCUR?

The pathophysiology of the aging spine in degenerative conditions has been well defined.  First, the intervertebral disc in the spine desiccates (dries up) and loses height.  The disc then loses its mechanical integrity (its ability to perform functions such as resisting motion) and bulges into the vertebral canal (the conduit in which the spinal cord, cauda equina, and nerve roots are housed).  The loss of the disc’s mechanical integrity allows motion either on a microscopic level (micromotion) or on a visually perceivable level (degenerative spondylolisthesis).  The ligamenta flava (the soft tissue covering the back of the spinal canal) thickens in reaction to the motion, after which it buckles in towards the spinal canal, further reducing the central space for the spinal cord.  Additionally, the facet joints degenerate and hypertrophy (grow in size), causing foraminal or lateral recess stenosis, which tends to pinch the nerve roots more than the spinal cord.   A Jersey City back pain specialist can help.


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