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

Abstract

Context: Spinal osteoid osteoma (OO) is an infrequent tumor and due to both its smallness and complex anatomy of the spine diagnosis is challenging. In addition, associated undefined soft tissue changes on magnetic resonance imaging (MRI) frequently cause misdiagnosis. Evidence Acquisition: PubMed database was searched for "spinal osteoid osteoma" and larger clinical series related to clinical pictures, diagnosis or treatment modalities, and also case reports with especially soft tissue changes and related to special treatment modalities were introduced to the study. It was aimed at to make conscious practitioners of clinical and diagnostic characteristics of spinal OOs. Results: Spinal OOs constitute about 10% of OOs and the most of the tumors are seen in adolescents or young adults. The most frequent clinical picture is painful scoliosis or torticollis according to the level of the tumor. On MRI that is the most frequently performed imaging modality in the patients with painful scoliosis, undefined extensive bone and soft tissue changes is quite frequent. Clinicians must be aware from these findings and they must suspect and investigate the patients with bone scintigraphy and thin sectioned computerized tomography that both of them together can show presence of the lesion and provide to determine exact location of the lesion. Despite the increasing number of the studies using percutaneous ablation techniques, standard treatment of spinal OOs is still intralesional excision. Surgical excision usually provides immediate pain relief, and recurrence is not frequent. Conclusions: Diffuse paravertebral muscle and soft tissue involvement having resemblance to myositis is not quite rare in the patients with spinal OO. This may be the sole finding on MRI and it must be alert for the clinicians to look for small OO nidus by bone scintigraphy or thin sectioned CT scan.

Osteoid Osteoma of the Lumbar Spine in a 3.5-Year-Old Boy

“…In this report, we described a case of osteoid osteoma at the lumbar spine of a 3.5-year-old boy that was managed successfully with the resection of the lesion. Although the diagnosis of spinal osteoid osteoma is equivocal, the careful examination of clinical and imaging workouts usually leads to the timely diagnosis of the case [3]. The histologic examination confirmed the diagnosis in our case, and his irritating back pain disappeared dramatically after the operation as was anticipated.…”

“…Particularly, spondylolysis may be easily confused with osteoid osteoma. However, perilesional bone edema is not distinctive on the MRI of the spondylolysis [3].…”

“…Painful scoliosis is prevalent in spinal osteoid osteoma, and (70%) of the cases complain of it. Soft tissue changes are also quite frequent and may lead to the misdiagnosis, or delay in the right diagnosis [3]. Pourfeizi et al have reported misdiagnosis rate as (54.5%) [4].…”