Osteoid Osteoma: Symptoms, Diagnosis and Treatment
Osteoid Osteoma is a bone tumor that is commonly seen in young males. Any bone of the body can be involved, but it is more common in the bones of the upper and lower limbs.
Most common bone in which it occurs is the femur or thigh bone. It can also occur in the vertebral column or spine.
The predominant symptom of osteoid osteoma is pain. Pain of the tumor is deep, dull and continuous in nature. Often the pain may be present for many months to years.
Typically the pain is worse in the night and is relieved by aspirin. If the tumor is located close to a joint then it can cause swelling, stiffness and deformity in the joint.
A tumor of the spine can cause pain and abnormal bending of the spine called scoliosis.
Occasionally there may be no pain and the only presenting feature may be swelling.
Diagnosis is made by x rays. As pain comes first then the tumor appears so at times the x rays may appear normal. X rays show thickening of the bone along with a area of clarity near the center of the thickening. This area is called the nidus of the tumor.
This is a x ray showing a osteoid osteoma in the femur. The red arrow points to the nidus.
A CT scan may be required if the nidus cannot be pin pointed accurately on x rays. This nidus is between 1 to 1.5 centimetre in size.
At times if the tumor is not visible even after repeated x rays then a bone scan may be required to establish the diagnosis if a osteoid osteoma is suspected by the history.
Treatment of this tumor can be of two types
Medical treatment is done by giving aspirin or other pain killer drugs as pain is the main symptom that the patient has. It has been observed that some tumors disappear spontaneously over time. So the basis of medical treatment is to provide relief from pain till the tumor resolves spontaneously.
This is only recommended for patients that are willing to take pain killers for months to years and have x rays every few months.
Medical treatment is not indicated or withdrawn in patients
- who have a deformity
- are sensitive to or can not tolerate pain killers
- and who have recurrence of pain at the regular doses of pain killers
Surgical treatment is done in patients who don't want medical treatment or in whom medical treatment is contraindicated.
During surgery the nidus has to be completely removed with a margin of surrounding bone or else the tumor will develop again. For complete removal it is essential that the surgeon can pin point the location of the nidus during operation.
Complete removal of the nidus results in a 100% cure. If the nidus remains then the tumor will recur. Recurrence usually occurs within a year.
At times a significant portion of bone may be removed and the remaining bone may require some support in the form of bone graft or implant.
Complications that may occur with this surgery include
- fracture of the bone
- stiffness of joints
As the nidus is the main crux of the treatment and it is a small 1 to 1.5 centimetre zone hence other minimal invasive methods of surgery have been developed that include
- Radio nucleotide guided surgical excision
- CT guided percutaneous excision
- Percutaneous radio-frequency ablation
- Percutaneous photo ablation
- Computer assisted surgery
These methods of treatment have a higher recurrence rate than conventional surgery. More than one sitting of these procedures may be required.
There main advantage is shorter hospital stay, faster recovery, minimal chance of bone fracture and joint stiffness.
Frequently Asked Questions
How long can medical treatment be taken?
Medical treatment can be taken for 1 to 2 years easily. Minimum dose required for pain relief should be used.
Can this tumor become malignant?
No malignant transformation of the tumor has been observed.
I hope the information provided was helpful. If you have any query you can ask me at the contact me page.
This page was created on 22st October 2010
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