ABSTRACT
Introduction: Back pain is the 5th most common reason for orthopaedic consultations, and is generally related to intervertebral disc and facet joint disease, muscular strain, or rarely (less than 1% of cases), to an unusual pathology such as a tumor of the spine. In young adults, spinal tumors are usually benign, and are often diagnosed late because the symptoms are chronic and non-specific, resembling those from the more common causes of back pain in this age group.
Case presentation: We describe two young patients who were presumed to have mechanical back pain and had been under conservative treatment (precautions, physiotherapy, medications) for more than a year, without improvement. The presence of “red-flag” symptoms, i.e. rest and night pain, as well as transient pain relief with aspirin, prompted us to do an isotope bone scan, which showed localized increased uptake in the lumbar spine in both patients, suggestive of osteoid osteoma. Thus, CT-scans were ordered which confirmed the diagnosis, and also permitted accurate pre-operative planning of tumor excision. As newer techniques of treatment such as radiofrequency ablation are potentially hazardous in the spine due to close proximity of neural structures, en-bloc surgical resection of the tumors was carried out with high-speed burr preserving the intervertebral and facet joints, resulting in patients returning to full function and complete resolution of long-standing back pain.
Conclusion: 1) A high index of clinical suspicion is required to diagnose osteoid osteomas of the spine, 2) precise radiological definition of the tumor location and size using high-resolution CT scan is essential for treatment planning and 3) surgical excision can be performed without compromising vertebral stability, obviating the need for spinal instrumentation and fusion.
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