Osteoid osteoma of the Dorsal spine: A case report with review of the literature

Introduction Osteoid osteoma was first described by Jaffe in 1935 to describe benign bony tumor characterized by presence of a nidus of osteoid vascular bone with dense sclerotic bone in its periphery [1]. It comprises 10% of all benign bone tumors and 1% of all spinal tumors [2]. The presentation is back pain which ranges from intermittent to continuous and intense; localized around level of lesion, having characteristic nocturnal rise which shows equivocal response to salicylates. Rarely do they present with painful scoliosis or neurodefecit [3]. It is difficult to diagnose osteoid osteoma on routine radiographs and exact diagnosis requires further imaging. We reported a case of osteoid osteoma of the dorsal spine in 27year-old male. Case Report A 27-year-old male presented with 3 years history of slowly progressive back pain with increase in intensity for last 6 months. The pain was associated with night time worsening. There was no history of constitutional symptoms or radicular symptoms. He gave no past history of tuberculosis. His treatment history included analgesics at various clinics till he got a MRI done at one centre which suspected an osteoid osteoma and was then referred to us. On examination, tenderness was present at upper dorsal spine level which aggravated with on twisting movement. There was no obvious scoliotic deformity or neurological involvement. His routine blood investigations were within normal limits. Radiographs of dorsal spine did not reveal any list. Repeat MRI was done at our centre which showed a well defined osteoid osteoma of size 6x5 mm in the right side of third dorsal lamina (Fig 1).Computed tomography (CT) of the same region was done to confirm the lesion which showed well-defined nidus surrounded by dense sclerotic bone in its periphery (Fig 2a, b). Decompressive surgery in form of laminectomy was done of the D3 lamina. The lamina was thinned out using a diamond tip burr and procedure completed using a num 1 Karrisons punch. No instrumentation was done. Post op patient had normal neurology and was ambulated second day. Repeat CT scans were done to document the correct level of surgery which showed complete removal of the tumor.(Fig 3). Histopathology confirmed the diagnosis of osteoid osteoma (Fig 4). Patient had complete recovery from the agonizing pain.