Back pain in children and adolescents

Back pain in children is a common problem that is infrequently reported to physicians. Persistent back pain in children is serious, and most conditions can be diagnosed with relatively simple tests, including diagnostic plain radiographs and bone scans. Many cases, including strains and sprains, are relieved with rest and decreased activity. If persistent back pain, increasing pain, fever, or neurologic deficit is present, referral to the orthopedic surgeon should be swift until a specific cause can be found and treated.

Osteoma of the long bones and the spine. A study of eleven patients and a review of the literature

The clinical features, radiographic and histopathological findings, treatment, and results are described for eleven patients who were managed for an extracranial osteoma at our medical center between 1980 and 1993. Ten of the patients were initially seen because of dull, aching bone pain that had been present for two weeks to thirty years. Radiographs demonstrated single or multiple homogeneous, well defined, radiodense foci with smooth round or lobulated margins. The histopathological features consistently included uniformly dense, compact, cortical-like, mature lamellar bone. The preoperative diagnosis was unclear for all patients, and osteoma was rarely considered in the differential diagnosis. For four patients, a tentative diagnosis of osteosarcoma was made, and a wide excision was carried out in two of these patients. Marginal excision with less than three millimeters of normal tissue around the lesion was performed in most patients. None of the osteomas recurred, and ten patients had relief of the pain. Awareness of the clinical, radiographic, and histopathological features of osteoma, as described, is valuable for making a differential diagnosis and for distinguishing osteomas from other lesions.

Clinicopathologic features and treatment of osteoid osteoma and osteoblastoma in children and adolescents

Benign bone-forming tumors are common in children. Careful radiographic imaging is necessary to plan surgical treatment. Careful histologic study is necessary to distinguish osteoblastoma from more aggressive tumors. Osteoid osteoma should be considered when the child or adolescent presents with pain in an extremity or along the spine.

Unusual presentation of an osteoid osteoma

We present a case of osteoid osteoma of the humerus diagnosed after it presented clinically as impingement syndrome. Clinical and magnetic resonance imaging data supported impingement, but standard non-surgical treatment did not provide complete pain relief. Subacromial injection resolved the anterior shoulder pain and unmasked medial arm and axillary pain. Humerus X-rays revealed a lytic diaphyseal lesion, and en-bloc resection of the humeral mass diagnosed an osteoid osteoma. This case is unusual in that only 1% of osteoid osteomas present in the humeral shaft. The clinical features and presentation of impingement and osteoid osteoma are discussed.

Osteoid osteoma of the pubic bone. Report of a case

Osteoid osteoma involves the pubic bone in exceptional cases. In this case report, a 23 year-old male patient with osteoid osteoma of the pubic bone, was presented. He was complaining of right groin pain, occurring nocturnally and being relieved by rest and analgesics. Radiographic examination revealed a small lesion in the right pubic bone. The patient was treated surgically, and the nidus was excised. The result of the histopathological examination was "osteoid osteoma". At 1 year postoperatively, recurrence was not seen. It was concluded that, if osteoid osteoma was located in an unusual site, more detailed radiographic examination should be done for exact localization, before the operation.

Clubbing of single digit: an unusual cause

We report a case of osteoid osteoma of the terminal phalanx of the little finger. The clinical presentation and radiographs are atypical.

Painless osteoid osteoma of the rib in an adult. A case report and a review of the literature

BACKGROUND

An asymptomatic rib lesion was discovered by means of a bone scan obtained during the clinical evaluation of an adult man with biopsy proven prostate adenocarcinoma. Clinically and radiologically considered to be a metastatic focus, on resection it proved to be an osteoid osteoma (OO).

METHODS

A review of the English medical literature on OO was conducted with emphasis on the occurrence in older patients, costal location, and the absence of pain.

RESULTS

OO in patients older than age 50 years is rare (1% - 2% of cases). Only 18 cases of painless OO were found. Of these, 8 (44%) occurred in the phalanges, and 3 (17%) in the cranial-facial bones, both uncommon sites for OO; only 7 (39%) arose in the long bones, the most common site for conventional OO. A disproportionate number of these patients (44%) were younger than age five years, a rarity for OO. Fourteen reported examples of costal OO were found, all of which were associated with pain. The possible mechanisms involved in the production of pain, including analysis of the effect of its site of origin and the presence of nerve fibers, is reviewed.

CONCLUSIONS

Costal OO is distinguished from osteoblastoma and from what has been described as painless fibro-osseous lesion of the rib. The infrequency of metastases as a cause of solitary rib lesion is emphasized.

Osteoid osteoma with a multicentric nidus

A case is reported of a 16-year-old boy who presented with continuous pain in his right leg. Cortical thickening and diffuse medullary sclerosis was revealed on x-ray of the distal tibia. CT imaging showed a circumscribed annular pattern extending some 2.5 cm-s and indicating the multifocal nature of the lesion. The diagnosis of multifocal osteoid osteoma was confirmed after histological examination of the block of resected bone.

Osteoid osteoma of the vertebral body with extension across the intervertebral disc

OBJECTIVE

To discuss a case of osteoid osteoma of the vertebral body with extension across the disc space, a very rare location and unique finding.

FEATURES

An 18-yr-old man suffered midthoracic pain that was thought to be related to a lifting injury. However, further evaluation revealed an osteoid osteoma of the T6 vertebral body. Special imaging revealed extension of the inflammatory component across the intervertebral disc involving the adjacent vertebral body.

INTERVENTION AND OUTCOME

The patient underwent vertebrectomy (resection of the osteoid osteoma) via a transpleural approach with T5 disc resection, sixth rib resection and rib strut graft insertion. Complete relief of the symptoms was reported almost immediately after surgery.

CONCLUSION

The vertebral body is a very unusual location for an osteoid osteoma and extension across the intervertebral disc is a unique finding. Surgical resection of the entire nidus yields optimum results.

[Contribution of nidus fluorescence in the surgical treatment of osteoid osteoma. Apropos of 17 cases]

PURPOSE OF THE STUDY

The severity of pain and functional disability contrast with the benignity and small size which characterize the osteoid osteoma. This study evaluates the clinical and histological efficiency of an intraoperative localization of the nidus by the tetracycline fluorescence test which is based on histomorphometric bone labeling techniques.

MATERIAL AND METHODS

17 out 25 osteoïd osteoma, operated between 1987 and 1995, had tetracycline fluorescence test. The patients received 1 gram orally during each of the 3 pre-operative days. Fluorescence under ultraviolet light was assessed on the removed specimen, and on the tumor site, before and after surgical resection.

RESULTS

At a mean follow-up of 39 months (12-85), 15 of the 17 patients (88 per cent) were painless. The result was always acquired within the first weeks after procedure. 2 patients had a primary failure due to incomplete removal of fluorescent nidus, and one was reoperated with success after one year. One patient had a false negative test although there was histological evidence of osteoid osteoma on the removed tissues with a complete relief of pain. In summary, the test was helpful in 14 cases (82 per cent) guiding "en bloc" resection or curetage, and allowing 70 per cent of histological nidus diagnosis.

DISCUSSION

This test is easy to carry out by pre-operative ingestion of tetracycline and only requires an ultra-violet light source. It demonstrated a good reliability which can be compared with that of more complex radio-labeling techniques or CT guided drill resections which impede histological confirmation in half of the cases. The fluorescence test allows a secure and precise procedure without complication, and we use it mainly for cancellous and superficial osteoid osteoma, and for revision of previous failed excisions. When the nidus is cortical and deeply located, radioguided techniques must be discussed.

[Osteoid osteoma of the temporal bone (mastoid). Report of one case]

The case of an osteoid osteoma of the right temporal bone (mastoid) in a 21-year-old woman is reported. The suspected diagnosis of osteoid osteoma was based in the retroauricular pain and the findings of the bone scintigraphy and computerized tomography (CT). Histological verification was made after surgical removal of the mass. After a 12-month-follow up, the patient remains asymptomatic.

Osteoid osteoma of the upper extremity

Osteoid osteomas, relatively rare lesions in the upper extremity, can be a persistent source of hand or wrist pain. Patients under age 40 who have otherwise unexplained pain should be evaluated. Relief of pain with oral nonsteroidal anti-inflammatory drugs should suggest the possibility of osteoid osteoma. Examination may demonstrate localized swelling or joint effusion. Radiographs should be examined for sclerosis in the region of pain. If radiographs are nondiagnostic, a bone scan should be obtained. If the nidus cannot be clearly visualized by radiography and bone scan, a CT scan should be obtained. If the location of the nidus makes excision difficult without removal of a large block of bone, localization with a CT-guided needle or by radioisotope labeling will help to assure removal of the nidus.

[The percutaneous CT-guided treatment of osteoid osteomas: a combined procedure with a biopsy drill and subsequent ethanol injection]

PURPOSE

The purpose of this study was the clinical evaluation of a percutaneous treatment modality in patients with an osteoidosteoma.

PATIENTS AND METHODS

6 patients with an osteoidosteoma of the upper (n = 1) and lower (n = 5) extremity which were confirmed on plain film radiographs and computed tomography underwent CT controlled drill biopsy of the nidus with subsequent injection of 96% ethanol into the biopsy channel to sclerose probably remaining remnants of the nidus. The procedure was started under local anaesthesia, but drilling of the nidus was carried out under a short general anaesthesia using ketamine.

RESULTS

The intervention was successful in all patients. No postinterventional infection occurred and no recurrence was observed in any of the patients in a follow-up time between 0.5 and 2 years.

CONCLUSION

Although only 6 patients were treated until now, we conclude that this combined procedure using a bone biopsy system and the subsequent injection of alcohol is a safe and successful procedure for percutaneous treatment of osteoidosteoma.

[Osteoid osteoma of the hand. Case representation with special reference to magnetic resonance tomography and litrature review]

The pre-operative diagnosis of osteoid osteoma of the first metacarpal bone was suggested by Magnetic Resonance Imaging in a 15 year old girl. As indicated in the literature, osteoid osteoma of the hand is relatively rare. The symptoms and the x-rays features of osteoid osteoma are essentially independent from the location consisting in rather unspecific pain and radiographically osteolytic nidus surrounded with sclerosis. In the few published cases with MR Imaging, the nidus shows high signal intensity surrounded by low signal intensity in the area corresponding to the radiographically visible sclerosis.

Osteoid osteoma of the hip. Percutaneous resection guided by computed tomography

Seven patients with a presumptive diagnosis of osteoid osteoma located at the hip were treated with percutaneous resection of the nidus through computed tomography guidance. Histologic confirmation was obtained in 5 of the 7 patients. The average hospital stay was 27 hours. At followup, from 12 to 40 months, all patients remain asymptomatic. This procedure presents potential advantages that traditional open surgery techniques do not have.

Osteoid osteoma of the tarsal cuboid presenting with recurrent ankle sprains in an adolescent: a case report

This case report illustrates an unusual cause of recurrent ankle sprains in a high school wrestler—osteoid osteoma of the cuboid bone in which the initial bone scan obtained was negative.

Case report 864. Elliptical, multicentric periosteal osteoid osteoma

An extremely rare case of multicentric periosteal osteoid osteoma in a child was presented. The lesions were found to be embedded in a narrow elliptical strip, suggesting the possibility that lesional tissue was stretched in a longitudinal fashion as a result of the rapid skeletal growth. In young patients with stretched periosteal reaction who complain of pain, multicentric osteoid osteoma should be suspected. These nidi can be obscured by the exuberant periosteal reaction. Accurate evaluation of the radiographic findings is very important.

Soft-tissue and bone tumors about the foot and ankle

The development of primary and malignant tumors of the soft tissues and bones of the foot and ankle are uncommon. A potential for misdiagnosis and increased morbidity exists for those patients who do indeed have a malignancy. This article illustrates the proper steps in staging lesions and the appropriate techniques for biopsy. This will help physicians to avoid undertreating malignant lesions, and, conversely, overtreating benign lesions.

Osteoid osteoma of the acetabulum. A case report

The acetabulum is a very rare location for osteoid osteoma. Reported herein is the case of a 21-year-old man who had nonspecific hip pain. Preoperative diagnosis was made 2 months after the first visit. Excisional biopsy was performed through the inner wall of the acetabulum. The patient reported complete relief from pain and there has been no evidence of recurrence in 8 years of followup.