From the Guidelines
Osteoid osteoma is a benign bone tumor characterized by a small growth called a nidus surrounded by reactive bone formation, typically affecting young people and causing pain that is worse at night and relieved by NSAIDs. According to the American College of Radiology 1, when radiographs or clinical presentation suggest osteoid osteoma, the next step involves further imaging studies. The key features of osteoid osteoma include:
- A small (less than 2 cm) nidus
- Reactive bone formation surrounding the nidus
- Typical age range of 10-30 years, with a male predominance
- Hallmark symptom of pain that is worse at night and relieved by NSAIDs like ibuprofen or naproxen
- Diagnosis often requiring imaging studies such as X-rays, CT scans (considered the gold standard) 1, and sometimes bone scans
- Treatment options including conservative management with NSAIDs, minimally invasive procedures like CT-guided radiofrequency ablation, or traditional surgical excision. The choice of treatment depends on various factors, including the location and size of the tumor, as well as the patient's overall health and preferences. CT-guided radiofrequency ablation is a highly effective treatment option, with a success rate of over 90%. It is essential to note that osteoid osteoma is not cancerous and does not transform into malignancy, which is crucial for patient understanding and management.
From the Research
Definition and Characteristics of Osteoid Osteoma
- Osteoid osteoma is a benign bone-forming tumor characterized by tumor cells directly forming mature bone 2.
- It accounts for around 5% of all bone tumors and 11% of benign bone tumors, with a male predilection 2.
- The tumor typically occurs in the long bones of the appendicular skeleton 2.
Symptoms and Diagnosis
- The most common symptom of osteoid osteoma is nocturnal pain, which usually responds to salicyclates and non-steroidal anti-inflammatory medications 2.
- CT is the modality of choice for diagnosis and specifying the location of the lesion 2.
- Osteoid osteoma can be classified based on location as cortical, cancellous, or subperiosteal 2.
Treatment Options
- Non-operative treatment can be considered as an option since the natural history of osteoid osteoma is that of spontaneous healing 2, 3.
- Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) can accelerate spontaneous healing 3.
- Surgical treatment is an option for patients with severe pain and those not responding to NSAIDs, including radiofrequency (RF) ablation, CT-guided percutaneous excision, and en bloc resection 2, 4, 5.
- Percutaneous ablation and open surgery are safe and reliable for osteoid osteoma, with percutaneous ablation having a higher technical success rate 4.