What is osteoid osteoma?
Osteoid osteoma is a benign but painful bone tumor. It is small in size and does not grow. It usually develops in the lower extremities of children and young adults, but also in the spine. It is estimated to account for 5% of bone tumors and 11% of benign bone tumors, making it an infrequent tumor.
There are basically three types of osteoid osteoma:
- Cancellous osteoid osteoma: It is inside the marrow, which leads to a delay in its diagnosis.
- Cortical osteoid osteoma: This is the most frequent and is characterized because its nidus (or nucleus) is well delimited in the cortex of the bone.
- Subperiosteal oisteoid osteoma: It generates great erosion in the bone cortex.
An osteoid osteoma is a painful benign tumor, common in children and young people.
Prognosis of the disease
Although osteoid osteoma is a completely benign tumor, it causes intense pain in the patient, conditioning his life and, consequently, everything that involves movement of the affected part and physical exercise.
The early detection of osteoid osteoma can avoid complications by compressing continuous tissues, destroying bone tissue by crushing, deforming the affected area aesthetically…
Osteoid osteoma symptoms
Osteoid osteomas may not cause symptoms in the patient, being small in size, so the clinic will depend on the location. However, the clinical manifestations can make the patient’s day-to-day life difficult. These manifestations are:
- Acute pain, as a consequence of compression of neighboring structures, such as nerves and muscles. This pain manifests itself mainly during the night, which is relieved with non-steroidal anti-inflammatory drugs.
- Functional limitation, if located in joints, which could cause the malfunction of the joint, even leading to functional disability.
- Aesthetic deformity, with consequent psychological repercussions.
- Possible growth retardation or bone didgenesis, if the osteoma is located in the growth plate itself.
Medical tests for osteoid osteoma
Diagnostic and localization methods for osteoid osteoma have improved in recent years, allowing better localization of the tumor. Thus, the use of radioisotope scanning or computed tomography (CT) allows the lesion to be localized for more effective and limited treatment, especially in deep or difficult to access tumors. They will also normally be accompanied, in order to make the most accurate diagnosis possible, by: X-rays, MRI scans, thin-slice CT scans, etc.
Its diagnosis is easy when the clinical presentation of symptoms is typical, but it is common for this type of tumor to be misdiagnosed, or for it to take a long time to be diagnosed. The period to diagnose it usually takes up to 28 months, with the consequences that it causes in the patient in terms of pain and mobility.
What are the causes of osteoid osteoma?
The causes of osteoid osteoma lie in an active and progressive increase in bone formation, which encapsulates until it forms a small tumor. The reason for this increased bone production is not fully understood. It is thought that it may be related to bone regeneration following minor trauma that does not create an obvious injury to the bone but does create inflammation of the bone.
This inflammation causes hemodynamic changes in the blood vessels, in terms of caliber and arteriolar flow, increasing them in order to feed the tissues to “repair” the damage. This causes the osteoblasts (precursor cells of mature bone) to multiply, forming a tumor structure that presses on the surrounding structures. This encapsulation allows the osteoma to self-limit.
Can it be prevented?
There is no clear solution to prevent osteoid osteoma, since it appears only as a consequence of the aforementioned processes.
Treatments for osteoid osteoma osteoid
It is usually treated with surgical ablation, to remove it. However, despite the small size of the lesion, it sometimes remains incomplete. In recent years maximum efforts have been made to minimize the bone resection margin, the chances of pathological fracture and the need for bone grafting. This reduces the patient’s convalescence time.
Diagnostic imaging tests will greatly assist the pediatric trauma specialist in locating the exact location of the lesion and in minimally invasive treatment of the patient.
In addition, minimally invasive techniques, such as percutaneous thermal treatment guided by computed tomography (CT) or percutaneous resection using radiofrequency or laser photocoagulation, are usually the methods of choice for treating osteoid osteoma. It is used whatever its location, provided that a good diagnosis is made beforehand based on the aforementioned scintigraphic and tomographic studies, as well as on the assessment and arguments of the specialist.
The procedure consists of localizing the lesion percutaneously with a needle and intraoperative control with CT. It is an intervention that is performed under general anesthesia, controlled at all times by specialists. Once the tumor is located with a CT scan, the needle is introduced into the lesion, extracting a sample to corroborate the diagnosis. It is then eliminated with radiofrequency (applying intense heat).
Depending on the location of the tumor, and if it is an area with many nerve endings (such as, for example, the spinal column), if there are complications, open surgery will be chosen to remove the tumor.
Which specialist treats it?
The specialist who treats osteoid osteoma is the expert in Traumatology and, specifically, in Pediatric Traumatology, since it is a pathology that affects mostly children. In case the patients are young adults, it will be the general traumatologist who will deal with it.