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Diagnostics (Basel, Switzerland) Jun 2023Benign tumours comprise the majority of primary vertebral tumours, and these are often found incidentally on imaging. Nonetheless, accurate diagnosis of these benign... (Review)
Review
Benign tumours comprise the majority of primary vertebral tumours, and these are often found incidentally on imaging. Nonetheless, accurate diagnosis of these benign lesions is crucial, in order to avoid misdiagnosis as more ominous malignant lesions or infection. Furthermore, some of these tumours, despite their benign nature, can have localised effects on the spine including neural compromise, or can be locally aggressive, thus necessitating active management. Haemangiomas and osteomas (enostosis) are the commonest benign tumours encountered. Others include osteoid osteoma, osteoblastoma, fibrous dysplasia, osteochondroma, chondroblastoma, haemangioma, simple bone cysts, aneurysmal bone cysts, giant cell tumours, eosinophilic granuloma and notochordal rests. The majority of lesions are asymptomatic; however, locally aggressive lesions (such as aneurysmal bone cysts or giant cell tumours) can present with nonspecific symptoms, such as back pain, neurological deficits and spinal instability, which may be indistinguishable from more commonly encountered mechanical back pain or malignant lesions including metastases. Hence, imaging, including radiography, computed tomography (CT) and magnetic resonance imaging (MRI), plays a critical role in diagnosis. Generally, most incidental or asymptomatic regions are conservatively managed or may not require any follow-up, while symptomatic or locally aggressive lesions warrant active interventions, which include surgical resection or percutaneous treatment techniques. Due to advances in interventional radiology techniques in recent years, percutaneous minimally invasive techniques such as radiofrequency ablation, sclerotherapy and cryoablation have played an increasing role in the management of these tumours with favourable outcomes. The different types of primary benign vertebral tumours will be discussed in this article with an emphasis on pertinent imaging features.
PubMed: 37370901
DOI: 10.3390/diagnostics13122006 -
Journal of Children's Orthopaedics Dec 2023The growing spine differs from the adult spine in several ways. Although tumors and infections cause only a small percentage of pediatric back pain incidences, delayed... (Review)
Review
The growing spine differs from the adult spine in several ways. Although tumors and infections cause only a small percentage of pediatric back pain incidences, delayed proper diagnosis and treatment may be disastrous. Benign lesions, such as osteoid osteoma, osteoblastoma, and aneurysmal bone cyst in the spine, are predominant during the first two decades of life, whereas malignant bony spinal tumors are rare. In the pediatric population, malignant spine tumors include osteosarcoma, Ewing's sarcoma, lymphoma, and metastatic neuroblastoma. Infections of the growing spine are rare, with the incidence of discitis peaking in patients under the age of 5 years and that of vertebral osteomyelitis peaking in older children. Spondylodiscitis is often a benign, self-limiting condition with low potential for bone destruction. Conservative treatments, including bedrest, immobilization, and antibiotics, are usually sufficient. Spinal tuberculosis is a frequently observed form of skeletal tuberculosis, especially in developing countries. Indications for surgical treatment include neurologic deficit, spinal instability, progressive kyphosis, late-onset paraplegia, and advanced disease unresponsive to nonoperative treatment. Spinal tumors and infections should be considered potential diagnoses in cases with spinal pain unrelated to the child's activity, accompanied by fever, malaise, and weight loss. In spinal tumors, early diagnosis, fast and adequate multidisciplinary management, appropriate en bloc resection, and reconstruction improve local control, survival, and quality of life. Pyogenic, hematogenous spondylodiscitis is the most common spinal infection; however, tuberculosis-induced spondylodiscitis should also be considered. level 4.
PubMed: 38050596
DOI: 10.1177/18632521231215857 -
Medical Science Monitor : International... Jun 2023BACKGROUND This retrospective study aims to compare the efficacy of computed tomography-guided percutaneous excision and radiofrequency ablation in the treatment of...
BACKGROUND This retrospective study aims to compare the efficacy of computed tomography-guided percutaneous excision and radiofrequency ablation in the treatment of osteoid osteoma. MATERIAL AND METHODS We evaluated 40 patients with osteoid osteoma who underwent either percutaneous excision or radiofrequency ablation between 2012 and 2015. The cohort consisted of 10 female and 30 male patients, with a mean age of 15.1 years (range: 4-27 years) and a mean follow-up time of 19.02 months (range: 11-39 months). Percutaneous excision was performed in 20 patients, while radiofrequency ablation was performed in the remaining 20 patients. RESULTS The success rates of percutaneous excision and radiofrequency ablation were comparable, with unsuccessful outcomes observed in 10% and 5% of patients, respectively. The reasons for failure in the percutaneous excision group were attributed to a marking error and incomplete excision of the wide-based nidus. Complications were limited to pathological fracture (n=1) and deep infection (n=1) in the percutaneous excision group, while no complications were encountered in the radiofrequency ablation group. CONCLUSIONS Both percutaneous excision and radiofrequency ablation demonstrate high success rates in treating osteoid osteoma. However, radiofrequency ablation offers the advantage of a quicker return to daily activities without the need for activity restrictions or splints. While being a more cost-effective option, percutaneous excision should be considered cautiously to minimize potential complications.
Topics: Humans; Male; Female; Adolescent; Bone Neoplasms; Retrospective Studies; Osteoma, Osteoid; Catheter Ablation; Radiofrequency Ablation
PubMed: 37349982
DOI: 10.12659/MSM.940292 -
RoFo : Fortschritte Auf Dem Gebiete Der... Nov 2023To assess diagnostic delay in patients with osteoid osteoma and to analyze influencing factors.
PURPOSE
To assess diagnostic delay in patients with osteoid osteoma and to analyze influencing factors.
MATERIALS AND METHODS
All patients treated for osteoid osteoma at our tertiary referral center between December 1997 and February 2021 were retrospectively identified (n = 302). The diagnosis was verified by an expert panel of radiologists and orthopedic surgeons. The exclusion criteria were post-interventional recurrence, missing data on symptom onset, and lack of pretherapeutic CT images. Clinical parameters were retrieved from the local clinical information system. CT and MR images were assessed by a senior specialist in musculoskeletal radiology.
RESULTS
After all exclusions, we studied 162 patients (mean age: 24 ± 11 years, 115 men). The average diagnostic delay was 419 ± 485 days (median: 275 days; range: 21-4503 days). Gender, patient age, presence of nocturnal pain, positive aspirin test, extent of bone sclerosis, and location of the tumor within bone and relative to joints did not influence diagnostic delay (p > 0.05). It was, however, positively correlated with nidus size (r = 0.26; p < 0.001) and was shorter with affection of long tubular bones compared to all other sites (p = 0.04). If osteoid osteoma was included in the initial differential diagnoses, the diagnostic delay was also shorter (p = 0.007).
CONCLUSION
The diagnostic delay in patients with osteoid osteoma is independent of demographics, clinical parameters, and most imaging parameters. A long average delay of more than one year suggests low awareness of the disease among physicians. Patients with unclear imaging findings should thus be referred to a specialized musculoskeletal center or an expert in the field should be consulted in a timely manner.
KEY POINTS
· In this retrospective study of 162 patients treated for osteoid osteoma, the median diagnostic delay was 275 days (range: 21-4503 days).. · Gender, age, presence of nocturnal pain, positive aspirin test, extent of bone sclerosis, and location of the tumor did not influence the diagnostic delay (p > 0.05).. · Diagnostic delay was positively correlated with nidus size (r = 0.26; p < 0.001) and was shorter with affection of long tubular bones compared to all other sites (376 ± 485 vs. 560 ± 462 days; p = 0.04)..
PubMed: 37995734
DOI: 10.1055/a-2203-2823 -
Journal of Children's Orthopaedics Oct 2023The purpose of this study is to develop an accessible step-wise management algorithm for the management of pediatric spinal osteoid osteomas (OOs) based on a systematic... (Review)
Review
PURPOSE
The purpose of this study is to develop an accessible step-wise management algorithm for the management of pediatric spinal osteoid osteomas (OOs) based on a systematic review of the published literature regarding the diagnostic evaluation, treatment, and outcomes following surgical resection.
METHODS
A systematic review of the literature was conducted on PubMed to locate English language studies reporting on the management of pediatric spinal OOs. Data extraction of clinical presentation, management strategies and imaging, and treatment outcomes were performed.
RESULTS
Ten studies reporting on 85 patients under the age of 18 years presenting with OOs were identified. Back pain was the most common presenting symptom, and scoliosis was described in 8 out of 10 studies, and radicular pain in 7 out of 10 studies. Diagnostic, intraoperative, and postoperative assessment included radiographs, computed tomography (CT) scans, magnetic resonance imaging (MRI), bone scans, and frozen section. Treatment options varied, including conservative management, open surgical resection with or without intraoperative imaging, and percutaneous image-guided treatment. All included studies described partial or complete resolution of pain in the immediate postoperative period.
CONCLUSIONS
The proposed algorithm provides a suggested framework for management of pediatric spinal OOs based on the available evidence (levels of evidence: 3, 4). This review of the literature indicated that a step-wise approach should be utilized in the management of pediatric spinal OOs.
PubMed: 37799321
DOI: 10.1177/18632521231192477 -
Cureus Nov 2023Osteoid osteoma is the most common benign osteogenic bone neoplasm. Osteoid osteomas are typically located in the metaphysis and diaphysis of long bones, especially the...
Osteoid osteoma is the most common benign osteogenic bone neoplasm. Osteoid osteomas are typically located in the metaphysis and diaphysis of long bones, especially the tibia and femur. However, less common sites of the skeleton can be affected as well, including carpal bones. Among carpal bones, the scaphoid and the capitate are the most affected. Osteoid osteoma of the trapezium is an extremely rare entity, with only seven cases reported in recent literature. We present a case of a 29-year-old male with persistent left wrist pain who was diagnosed with an osteoid osteoma of the trapezium bone. The diagnosis was based on the patient's history, clinical examination and findings from the CT scan, MRI, and plain radiographs. The patient was treated with an excision biopsy with no additional bone grafting. After a follow-up period of 12 months, no pain or signs of recurrence were present. We conducted a literature review to elucidate the clinical presentation as well as the proper diagnostic tools and therapeutic methods for this rare occurrence.
PubMed: 38106747
DOI: 10.7759/cureus.48889