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Osteoid Osteoma

They usually emerges sometime during the teenage years or early adulthood. The condition seems to occur more often in males than females. These tumours, while causing painful symptoms, typically do not progress or harm the host bone, although in young children, those located near a growth plate, may deform the host bone, or stimulate the bone to grow larger or longer. They do not, however, metastasise (spread) beyond the bone. If located near a joint, they may be associated with swelling or fluid in the joint.

What causes an Osteoid Osteoma?
An osteoid osteoma occurs when certain cells divide uncontrollably, forming a small mass comprised of bone and other tissue. This growing tumour replaces healthy bone tissue with abnormal, hard bone tissue. No one knows exactly why this occurs.

What are the symptoms of Osteoid Osteoma?
The following are the most common symptoms of an osteoid osteoma. Keep in mind that each individual may experience symptoms differently:

  • Dull or sharp pain that worsens at night
  • Pain that is usually relieved by aspirin or other anti-inflammatory drugs
  • Limping
  • Painful Scoliosis and muscle spasticity (when tumour is located in the spine)
  • Growth disturbance (when tumour is involved with a bone's growth plate)
  • Muscle atrophy
  • Bowing deformity
  • Nerve symptoms (like sciatica) when located in the spine

The signs and symptoms of osteoid osteoma may resemble other medical conditions or problems. Occasionally children with undiagnosed osteoid osteomas have been thought to have a psychological or psychiatric condition. Always consult a physician for a diagnosis.

How is Osteoid Osteoma diagnosed?
In addition to taking a complete physical and performing a full medical examination, your child's doctor may use any of the following tests (alone or in combination) to diagnose osteoid osteoma:

  • X-rays - a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Computerized Tomography scan (also called CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices) both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. This test is also particularly useful in identifying tumours located in the spine, which are difficult to image on a plain x-ray.
  • Magnetic Resonance Imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body. This test is particularly useful in identifying tumours in areas that are difficult to image on a plain x-ray, such as the spine. However, in diagnosing osteoid osteoma, a CT scan (described above) is preferred over an MRI.
  • Bone scan - a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumours; to determine the cause of bone pain or inflammation.
    Complete blood count (CBC) - a measurement of size, number and maturity of different blood cells in a specific volume of blood
    Blood tests - (including blood chemistries)

How is an Osteoid Osteoma treated?
Specific treatment for an osteoid osteoma will be determined by your child's physician based on:

  • Your child's age, overall health, and medical history
  • Extent of the disease
  • Your child's tolerance for specific medications, procedures, or therapies
  • How your child's physician expects the disease may progress
  • Your opinion or preference

Treatment for osteoid osteoma traditionally involved an operation to remove the tumour performed by an orthopaedic surgeon. More recently, many osteoid osteomas have been treated by the radiologist using the technique known as percutaneous radiofrequency ablation. This is a minimally invasive procedure in which radio frequencies are passed beneath the skin through a needle to kill the tumour cells by heating them to a high temperature. This technique is performed by the radiologist in a CT scan under general anaesthesia. The advantage is that this is a day procedure that does not significantly weaken the bone. It quite successfully cures the tumour and relieves the pain and has much less morbidity than an operation. This method cannot be used to treat tumours of the spinal column, but in other locations has largely replaced operations.

In some cases, if the doctor determines that heat ablation cannot be used to treat your child's osteoid osteoma (i.e. if the tumour is in the spinal column) than your child may need an operation. In most cases, surgery alone, without complimentary therapies, is all that is necessary.

The following surgical procedures are among those used to treat osteoid osteoma:

  • Curettage: Most osteoid osteoma that are surgically treated are treated by curettage to remove only the tumor. Curettage is an operation during which the tumour is scraped out of the bone with a special instrument called a curette that has a scoop, loop or ring at its tip. For this procedure, surgeons make an incision in the bone to create a window. Sometimes special imaging techniques (such as bone scans) are needed to locate the tumour in the operating room. The tumour is completely curetted and the remaining cavity is then packed with donor bone tissue (allograft), bone chips taken from another bone (autograft), or other materials depending on the preference of the surgeon.
  • En bloc resection: If more aggressive resection of the tumour is warranted (not typically the case in osteoid osteoma), the operation will likely involve en bloc resection, which is the surgical removal of bone containing the tumour, with wide margins of healthy tissue surrounding the tumour. This type of operation is seldom performed today.
  • Internal fixation: The use of metal rods or pins in reconstruction of the bone after the tumour is excised.

What is the long-term outlook for a patient with an osteoid osteoma?
Prognosis for an osteoid osteoma is generally excellent, although prognosis varies from individual to individual depending on: how active the tumour is:

  • The tumour's response to therapy
  • The age and overall health of your child
  • Your child's tolerance for specific medication, procedures or therapies.

Most of these tumours can be successfully treated. However, recurrence can occur. Continuous follow-up care is essential for the successful treatment of an osteoid osteoma. A schedule of follow-up care should be determined by your child's physician and other members of your care team to monitor ongoing response to treatment and possible late effects of treatment.