Osteoid osteoma of the first 2 cervical vertebrae

Abstract

Osteoid osteoma affects the spine in only 10% of cases. More than 50% of the spinal cases involve the lumbar and cervical vertebrae. Involvement of C-1 and C-2 vertebrae has previously been reported only very rarely in the published literature. The authors report 4 cases of upper cervical osteoid osteoma, 1 involving C-1 and the other 3 C-2, and they discuss different aspects of management in similar cases. The patients were 14, 17, 35, and 46 years old, and all presented with neck pain and various degrees of painful limitation of head rotation not ameliorated by ordinary analgesics. Radionuclide isotope bone scans, CT scanning, and MR imaging were helpful preoperative diagnostic modalities. The first attempt at eradication of the lesions failed in 2 cases and the lesions could be excised totally at a second approach. Postoperatively, the patients all became pain free and gained full range of neck motion. There has been no tumor recurrence and no sign of instability in short- to medium-term follow-up. Among the several etiologies mentioned for neck pain and torticollis, osteoid osteoma of the first 2 cervical vertebrae should be considered as a possible but rare cause. Even though different kinds of management have been mentioned for osteoid osteoma, resection of the lesion remains the best option for achieving a cure.

Spinal Osteoid Osteoma Associated With Soft Tissue Changes as a Challenging Diagnosis: A Review of the Literature

“…It was first reported by Bergstrand in 1930 (2) and it was defined as a different entity by Jaffe in 1935 (3). Osteoid osteoma is a relatively frequent tumor and it constitutes 10.8% to 13.5% of all primary benign bone tumors (2).…”

“…Although OO is a relatively frequent tumor that constitutes over 10% of all benign bone tumors, it is infrequently located in the spine, and only under 10% of the lesions occur in the spine (2,5). In a study from pathology laboratory of a big university hospital, only 8 out of 131 OOs were located in the spine or sacrum (6.1%) (5).…”

“…Frequently, scoliosis or torticollis associates to the pain according to the level of the lesion. Two of the important characteristics of this pain are to increase at night and to relieve by oral salicylic acid or other nonsteroidal anti-inflammatory drugs (NSAID) (2). It is classically unrelated to activity (14), and is initially dull, throbbing, and intermittent and becomes more intense and knifelike over time (19).…”

“…Its nidus contains thick internal trabecular bone embedded within a low-density matrix (2). The nidus is radiolucent on radiographs and low attenuation on CT because it contains numerous osteoblasts with fibrous tissue richly supplied by blood vessels that are larger than normal (34).…”

Endoscopic excision of C2 Osteoid Osteoma: a technical case report

“…Ten percent of the lesions occur in the spine, rarely within the vertebral body [1]. C2 is an extremely rare site for a lesion of OO [2].…”