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Osteoid osteoma

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Physical findings

  • Spinal lesions can present with scoliosis
  • Intracapsular lesions can cause joint effusion

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Bone scan

  • Hot on bone scan
  • May be difficult to identify nidus due to uptake in surrounding periosteal reaction

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Differential diagnosis

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Natural history

  • Spontaneous regression of clinically and radiologically diagnose osteoid osteomas can occur during an average of 4-6 years
  • Nidus gradually calcifies, ossifies, and finally, blends into the sclerotic surrounding bone
  • Many patients able to tolerate the pain with or without the prolonged use of NSAIDs
    • Those who cannot are candidates for surgical intervention

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Diagnosis and treatment

  • Most osteoid osteomas should be diagnosed by imaging
  • Natural history is to undergo spontaneous resolution after a variable amount of time
  • If pain is unresponsive to anti-inflammatories or if patient cannot tolerate the medication, treat lesion surgically
  • Lesion can be resected or ablated percutaneously under radiographic control, ablated with a radiofrequency technique or toxic substance (for example, alcohol), curetted, or resected en bloc
    • Curettage has higher risk of recurrence than complete resection
    • En bloc resection has lower risk of relapse, but higher likelihood of requiring a reconstructive procedure folowing lesional remova.
  • Specimen can be x-rayed to ensure complete resection.
  • Defect left by removal of lesion should be bone grafted or instrumented if there is risk of fracture

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Absolute contraindications to medical therapy

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