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Pannu CD, Hess M, Baxter D. Osteoid osteoma presenting with scoliosis: successful resection with endoscopic excision. BMJ Case Rep 2024; 17:e258346. [PMID: 38453226 PMCID: PMC10921494 DOI: 10.1136/bcr-2023-258346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
A young male in his mid-teen years presented with severe back pain for 3 months and was subsequently diagnosed with osteoid osteoma in the left superior articular process of the L4 vertebra. Initial treatment with non-steroidal anti-inflammatory drugs provided temporary relief. Due to concerns about scoliosis progression along with unrelieved pain, a multidisciplinary team recommended endoscopic excision of the osteoid osteoma. The procedure resulted in complete pain relief and an improvement in the scoliosis curve from 22° of Cobb's angle to 12 degrees at the 8-month follow-up.
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Affiliation(s)
- Chaitanya Dev Pannu
- Specialist Surgery, Royal National Orthopaedic Hospital NHS Trust, London, UK
| | | | - David Baxter
- Neurosurgery, Royal National Orthopaedic Hospital NHS Trust, London, UK
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Giammalva GR, Dell’Aglio L, Guarrera B, Baro V, Calvanese L, Schiavo G, Mantovani G, Rinaldi V, Iacopino DG, Causin F, Nicolai P, Ferrari M, Denaro L. Transnasal Endoscopic Approach for Osteoid Osteoma of the Odontoid Process in a Child: Technical Note and Systematic Review of the Literature. Brain Sci 2022; 12:brainsci12070916. [PMID: 35884723 PMCID: PMC9316770 DOI: 10.3390/brainsci12070916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
Osteoid osteoma (OO) is a primary benign tumor that accounts for up to 3% of all bone tumors. The cervical spine is less affected by OOs, and very few cases of C2 OOs have been reported in the literature, both in adults and children. Surgery may be required in case of functional torticollis, stiffness, and reduced range of motion (ROM) due to cervical OOs refractory to medical therapy. Several posterior and anterior surgical techniques have been described to remove C2 OOs. In particular, anterior approaches to the cervical spine represent the most used surgical route for treating C2 OOs. We describe the first case of OO of the odontoid process removed through a transnasal endoscopic approach with the aid of neuronavigation in a 6-year-old child. No intraoperative complications occurred, and the post-operative course was uneventful. The patient had immediate relief of neck pain and remained pain-free throughout the follow-up period, with complete functional recovery of the neck range of motion (ROM). In this case, based on the favorable anatomy, the transnasal endoscopic approach represented a valuable strategy for the complete removal of an anterior C2 OO without the need for further vertebral fixation since the preservation of ligaments and paravertebral soft tissue.
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Affiliation(s)
- Giuseppe Roberto Giammalva
- Unit of Neurosurgery, Post Graduate Residency Program in Neurosurgery, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy;
- Correspondence:
| | - Letizia Dell’Aglio
- Academic Neurosurgery, Department of Neurosciences DNS, University of Padua, 35128 Padua, Italy; (L.D.); (B.G.); (V.B.); (L.D.)
| | - Brando Guarrera
- Academic Neurosurgery, Department of Neurosciences DNS, University of Padua, 35128 Padua, Italy; (L.D.); (B.G.); (V.B.); (L.D.)
| | - Valentina Baro
- Academic Neurosurgery, Department of Neurosciences DNS, University of Padua, 35128 Padua, Italy; (L.D.); (B.G.); (V.B.); (L.D.)
| | - Leonardo Calvanese
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Neurosciences DNS, “Azienda Ospedale Università di Padova”, University of Padua, 35128 Padua, Italy; (L.C.); (G.S.); (P.N.); (M.F.)
| | - Gloria Schiavo
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Neurosciences DNS, “Azienda Ospedale Università di Padova”, University of Padua, 35128 Padua, Italy; (L.C.); (G.S.); (P.N.); (M.F.)
| | - Giulia Mantovani
- Unit of Anesthesia and Intensive Care, Integrated Didactic-Scientific Healtcare Department of Surgery (DIDAS Chirurgia), “Azienda Ospedale Università di Padova”, University of Padua, 35128 Padua, Italy; (G.M.); (V.R.)
| | - Valentina Rinaldi
- Unit of Anesthesia and Intensive Care, Integrated Didactic-Scientific Healtcare Department of Surgery (DIDAS Chirurgia), “Azienda Ospedale Università di Padova”, University of Padua, 35128 Padua, Italy; (G.M.); (V.R.)
| | - Domenico Gerardo Iacopino
- Unit of Neurosurgery, Post Graduate Residency Program in Neurosurgery, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy;
| | - Francesco Causin
- Unit of Neuroradiology, Department of Neurosciences DNS, University of Padua, 35128 Padua, Italy;
| | - Piero Nicolai
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Neurosciences DNS, “Azienda Ospedale Università di Padova”, University of Padua, 35128 Padua, Italy; (L.C.); (G.S.); (P.N.); (M.F.)
| | - Marco Ferrari
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Neurosciences DNS, “Azienda Ospedale Università di Padova”, University of Padua, 35128 Padua, Italy; (L.C.); (G.S.); (P.N.); (M.F.)
- Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON M5G 2C4, Canada
- Technology for Health (Ph.D. Program), Department of Information Engineering, University of Brescia, 25123 Brescia, Italy
| | - Luca Denaro
- Academic Neurosurgery, Department of Neurosciences DNS, University of Padua, 35128 Padua, Italy; (L.D.); (B.G.); (V.B.); (L.D.)
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Kotheeranurak V, Jitpakdee K, Rujiramongkolchai N, Atikankul T, Singhatanadgige W, Limthongkul W, Tejapongvorachai T, Kim JS. Remodeling of the Lumbar Facet Joint After Full Endoscopic Resection for Lumbar Osteoid Osteoma: Case Report and Literature Review. Int J Spine Surg 2022; 16:378-383. [PMID: 35273115 PMCID: PMC9930653 DOI: 10.14444/8210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Osteoid osteoma (OO) is a common benign bone tumor; however, approximately 25% of cases have spine involvement. It is often treated by image-guided radiofrequency ablation to break down the nidus. Few reports have described full endoscopic resection of the lesion, but none have described postoperative remodeling of the lumbar facet joint after surgical resection of an OO. The study aimed to describe a rare case of remodeling of the lumbar facet joint and then delineate the least invasive surgical technique of endoscopic resection of an OO. METHODS A 26-year-old man presented with severe left buttock pain and sciatica that worsened at night and was relieved by ibuprofen. Magnetic resonance imaging indicated a left inferior facet of an L3 mass-like lesion. A thin-section computed tomography image revealed a nidus, which was compatible with an OO. Full endoscopic resection was performed to completely remove the nidus of the OO. RESULTS At the 2-year follow-up, the patient was symptom-free and computed tomography images indicated new bone formation. CONCLUSIONS The present case and literature review demonstrate that endoscopic resection is safe and effective for managing a posterior element of lumbar OO. Furthermore, this technique allows complete removal of the nidus with minimal damage to surrounding structures and leads to remodeling of the resection site. CLINICAL RELEVANCE Patients with OO involving the posterior element of the spine can present with buttock and radicular pain, mimicking lumbar disc herniation. OO can be successfully removed by the full endoscopic method and remodeling of the resected site can be anticipated. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Vit Kotheeranurak
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand
| | - Khanathip Jitpakdee
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand
| | | | - Taywin Atikankul
- Department of Pathology, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand
| | | | - Worawat Limthongkul
- Department of Orthopaedic, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary’s Hospital, Spine Center, College of medicine, The Catholic University of Korea, Seoul, South Korea
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Basma J, Rangarajan SV, Michael LM, Magnuson JS, Muhlbauer MS, Gleysteen JP. Robotic-Assisted Tubular Transoral Parapharyngeal Approach to the Ventral Craniovertebral Junction. Oper Neurosurg (Hagerstown) 2021; 21:14-19. [PMID: 33647934 DOI: 10.1093/ons/opab042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/25/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Transoral robotic surgery (TORS) has become a routine technique for treating benign and malignant lesions of the oropharynx with the advantage of reducing morbidity compared to open surgical techniques. However, TORS has not been used routinely for accessing lesions of the spine. OBJECTIVE To describe how TORS can be used to access spinal lesions. METHODS We describe our technique of accessing the parapharyngeal space using the robotic technique, and then dissecting the prevertebral muscles to expose the ventral craniovertebral junction. Tubular retraction with endoscopic visualization is then employed for surgical resection. We then report a case of a 14-yr-old competitive athlete who presented with an osseous lesion of C1, which underwent resection using this novel TORS approach. RESULTS Our patient underwent successful resection of a lateral C1 osteoid osteoma utilizing a combined TORS/endoscopic approach. She tolerated soft diet immediately and was discharged on postoperative day 2. Postoperative imaging revealed complete resection of the lesion, and she returned to competitive athletics within 6 wk. CONCLUSION Utilizing this novel, robotic-assisted approach can definitively treat osseous cervical spine lesions while reducing morbidity, allowing for early return to normal diet and minimizing overall length of hospital stay.
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Affiliation(s)
- Jaafar Basma
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sanjeet V Rangarajan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - J Scott Magnuson
- Head and Neck Surgery Program, Advent Health Orlando, Orlando, Florida, USA.,Department of Otolaryngology, College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Michael S Muhlbauer
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - John P Gleysteen
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Barzilai O, Robin AM, O'Toole JE, Laufer I. Minimally Invasive Surgery Strategies: Changing the Treatment of Spine Tumors. Neurosurg Clin N Am 2020; 31:201-209. [PMID: 32147011 DOI: 10.1016/j.nec.2019.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Innovation in surgical technique and contemporary spinal instrumentation paired with intraoperative navigation/imaging concepts allows for safer and less-invasive surgical approaches. The combination of stereotactic body radiotherapy, contemporary surgical adjuncts, and less-invasive techniques serves to minimize blood loss, soft tissue injury, and length of hospital stay without compromising surgical efficacy, potentially enabling patients to begin adjuvant treatment sooner.
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Affiliation(s)
- Ori Barzilai
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, 1275 York Avenue, New York, NY 10065, USA
| | - Adam M Robin
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI, USA
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA
| | - Ilya Laufer
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, 1275 York Avenue, New York, NY 10065, USA.
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Pipola V, Tedesco G, Spinnato P, Facchini G, Gala RB, Bandiera S, Bròdano GB, Terzi S, Ghermandi R, Evangelisti G, Ricci A, Griffoni C, Pezzi A, Gasbarrini A. Surgery Versus Radiofrequency Ablation in the Management of Spinal Osteoid Osteomas: A Spine Oncology Referral Center Comparison Analysis of 138 Cases. World Neurosurg 2020; 145:e298-e304. [PMID: 33068800 DOI: 10.1016/j.wneu.2020.10.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Osteoid osteomas (OOs) are benign bone forming tumors that, usually, occur in the extremities, with about 10% of them arising in the spine more commonly in the posterior elements. The aim of this study is to evaluate the long-term results of patients suffering from spinal OO treated with surgery and radiofrequency ablation. METHODS This was a retrospective comparison analysis of data prospectively collected from 2 cohorts of consecutive patients diagnosed with OO of the spine treated at the same Institute from November 2002 to February 2019. The first cohort included patients submitted to an intralesional extracapsular excision of the lesion (surgery group); the second cohort included patients submitted to radiofrequency ablation (RFA group). RESULTS The surgery group showed a local recurrence rate of 1.7% versus a recurrence rate of 12.5% in the RFA group with a statistically significant difference in the disease-free survival at longest follow-up (P = 0.012). No statistically significant differences were observed in local recurrence rate stratified for level and site of lesion. No complications were observed in both groups at the time of first procedure. CONCLUSIONS Surgery and RFA are both safe and effective interventional procedures for the management of spinal OO, although RFA is associated with a greater recurrence rate. Treatment should be tailored according to the relationship of lesions with neural structures and to advantages and disadvantages of each technique.
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Affiliation(s)
- Valerio Pipola
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Giuseppe Tedesco
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Spinnato
- Department of Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giancarlo Facchini
- Department of Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Stefano Bandiera
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Barbanti Bròdano
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvia Terzi
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Riccardo Ghermandi
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gisberto Evangelisti
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Ricci
- Department of Anesthesia-Resuscitation and Intensive Care, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cristiana Griffoni
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Pezzi
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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A technical case report on use of tubular retractors for anterior cervical spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:1454-1459. [PMID: 29260308 DOI: 10.1007/s00586-017-5423-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/23/2017] [Accepted: 12/09/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE The authors put-forth this technical report to establish the feasibility of performing an anterior cervical corpectomy and fusion (ACCF) and a two-level anterior cervical discectomy and fusion (ACDF) using a minimally invasive approach with tubular retractors. METHODS First case: cervical spondylotic myelopathy secondary to a large postero-inferiorly migrated disc treated with corpectomy and reconstruction with a mesh cage and locking plate. Second case: cervical disc herniation with radiculopathy treated with a two-level ACDF. Both cases were operated with minimally invasive approach with tubular retractor using a single incision. Technical aspects and clinical outcomes have been reported. RESULTS No intra or post-operative complications were encountered. Intra-operative blood loss was negligible. The patients had a cosmetic scar on healing. Standard procedure of placement of tubular retractors is sufficient for adequate surgical exposure with minimal invasiveness. CONCLUSION Minimally invasive approach to anterior cervical spine with tubular retractors is feasible. This is the first report on use of minimally invasive approach for ACCF and two-level ACDF.
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Microendoscopic Excision of Osteoid Osteoma in the Pedicle of the Third Lumbar Vertebra. Asian Spine J 2015; 9:958-61. [PMID: 26713130 PMCID: PMC4686404 DOI: 10.4184/asj.2015.9.6.958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 01/29/2015] [Accepted: 02/12/2015] [Indexed: 11/24/2022] Open
Abstract
We present a rare case of a patient who underwent complete microendoscopic excision of an osteoid osteoma, which induced radiculopathy without nerve root compression. A 20-year-old man presented severe right groin pain that was temporarily relieved by nonsteroidal anti-inflammatory drugs. A computed tomography (CT) scan showed typical features of a nidus located in the inferior cortex of the right L3 pedicle. We performed surgery using a posterior microendoscopic approach. We drilled vertically along the line of the cortex of the caudal pedicle using a high-speed drill. After identifying the tumor, en bloc resection of the nidus was achieved. Immediately after surgery, pain in the right groin disappeared. A CT scan showed that most of the right L3 pedicle remained. This minimally invasive technique preserves spinal structures, including the facet and pedicle, and is a viable option for the treatment of spinal osteoid osteomas located close to vital structures.
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Moraes OJS. Expert's Comment concerning Grand Rounds case entitled "Diagnosis and treatment of a C2-osteoblastoma encompassing the vertebral artery" (by Stavros I. Stavridis, Andreas Pingel, Klaus John Schnake and Frank Kandziora). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:2513-4. [PMID: 24197482 DOI: 10.1007/s00586-013-3081-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Osmar J S Moraes
- Neurosurgery Department, Santa Marcelina's University Hospital-Medical School, R. Maestro Cardim, 591. 11 Floor, Sao Paulo, SP, 0541-300, Brazil,
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Case report: Curetting osteoid osteoma of the spine using combined video-assisted thoracoscopic surgery and navigation. Clin Orthop Relat Res 2013; 471:680-5. [PMID: 23212772 PMCID: PMC3549152 DOI: 10.1007/s11999-012-2725-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/19/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND A spinal osteoid osteoma is a rare benign tumor. The usual treatment involves complete curettage including the nidus. In the thoracic spine, conventional open surgical treatment usually carries relatively high surgical risks because of the close anatomic relationship to the spinal cord, nerve roots, and thoracic vessels, and pulmonary complications and postoperative pain. CASE REPORT We report the case of a 16-year-old girl with a symptomatic osteoid osteoma at the T9 level whose lesion was currettaged using video-assisted thoracoscopic surgery (VATS) guided by a navigation system (VATS-NAV). There were no complications and the patient had immediate relief of the characteristic pain after surgery and was asymptomatic at 5 months' followup. LITERATURE REVIEW Progressive advances in the technology of spinal surgery have evolved to offer greater safety and less morbidity for patients. The advent of minimally invasive surgery has expanded the indications for VATS for anterior spinal disorders. Spinal navigation systems have become useful tools allowing localization and excision of the nidus of osteoid osteomas with minimal bone resection and without radiation exposure. CLINICAL RELEVANCE The VATS-NAV combination in our patient allowed accurate localization and guidance for complete excision of a spinal osteoid osteoma through a minimally invasive approach without compromising spinal stability.
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