Osteoid Osteoma and Osteoblastoma of the Spine / 대한척추외과학회지

ABSTRACT

STUDY DESIGN: A retrospective study OBJECTIVE: To analyze the clinical and radiological findings, and the results of the surgical treatment of osteoid osteomas and osteoblastomas of the spine. SUMMARY OF LITERATURE REVIEW With the development of new imaging techniques, earlier diagnoses have been reported. However, a few reports of unexpected misdiagnosis, and postoperative results, have also been published. MATERIALS AND METHODS: Between January 1980 and September 2002, twelve patients were diagnosed with an osteoid osteoma or osteoblastoma of the spine, and were surgically treated. The average preoperative symptom-duration and follow-up period were 20 and 33 months, with ranges from 6weeks to 96 months, and 4 to 120 months, respectively. All the patients were younger than 30 years old, with the majority being of growing age, and underwent at least a bone scan, CT or MRI, as part of the diagnostic procedures. RESULTS: The most common symptom was pain at the lesion, with 2 torticollis and 4 scoliosis observed as combined spine deformities, respectively. Neurological abnormalities were seen more often in the osteoblastomas (80%) than in the osteoid osteomas (43%). From the radiological findings, a CT scan was a more effective procedure than any of the other diagnostic modalities in differentiating an osteosclerotic bony lesion and a nidus. In three out of the five MRI, 2 cases were misdiagnosed as infections and the other as a malignant tumor, with no significant abnormal findings in the simple roentgenogram. A wide excision was performed in all patients, and a fusion, with a bone graft, was also performed in 8. There were no postoperative spinal instabilities or complications. CONCLUSION: In a differential diagnosis, careful history taking for pain, and a physical examination for spine deformity, are required. Without any clinical information, these tumors can be misdiagnosed as malignant tumors, or other infectious diseases, in a MRI. With regard to the surgical treatment, there were no cases of recurrence reported due to the wide excision, but a fusion, both with or without instrumentation, can be considered to prevent postoperative spine instability.