Back pains in most cases are mechanical and we find signs of wear and tear on imaging tests that do not explain everything. Sometimes, however, much more rarely, we find a specific cause such as a tumor. Today I’m going to talk about a benign tumor that can be found in the spine that is the osteoid osteoma.
This tumor is typical that we find it in the second decade of life, especially in males (three times more frequent). The column is not your favorite site but it can appear here. It is more common to see it in the femur and tibia.
Being a tumor that appears in the growing age, it is possible that we find it in a patient with scoliosis. As a general rule, scoliosis in a child does not produce significant pain. By this I mean that scoliosis will not cause pain that limits your life or need medication on a regular basis. If it is not, and we have a pain that does not allow us to do sports or wake us at night, we have to look for the cause, because there is usually. In these cases we find an explanation in another lesion added to scoliosis. One of these is osteoid osteoma.
What are the symptoms of osteoid osteoma?
The main symptom of osteoid osteoma is pain. It is a pain that progressively increases regardless of the activity we do. Typically the pain can be worse at night. The rest of the symptoms depend on where the tumor is. In the back it causes limitation of the mobility by pain and the contracture of the surrounding muscles. Sometimes the tumor can compress other structures such as a nerve root and give other types of added symptoms such as sciatica. If the tumor is in the femur or tibia produces pain in this area with inflammation, limp and even deformity in the area of the bone that hurts.
There is a detail that is very characteristic of this tumor and is that the pain is relieved with aspirin after having taken it. Other anti-inflammatory drugs are also available. This is because aspirin and anti-inflammatories inhibit prostaglandins. The prostaglandins are substances with diverse functions in our organism and that participate in the inflammatory processes. High levels of prostaglandins occur at the center of this tumor (nidus). This effect is one of the details that guide us to the diagnosis.
How is the diagnosis of osteoid osteoma?
The diagnosis is made with imaging tests in a patient presenting the suggestive symptoms of having this lesion. Plain radiography can give us the diagnosis in many cases, but not always. TAC (scanner) is the best way to see it, especially in the spine, which can go unnoticed on radiographs more often. It will also be seen on MRI.
It is important to differentiate it from a benign tumor that is very much like osteoblastoma. This tumor, although benign, tends to grow and if we do not act on it can end up producing neurological damage. Osteoid osteoma does not grow and rarely measures more than one and a half centimeters.
What is the treatment of osteoid osteoma?
In order to look for the best treatment it is necessary to take into account that the osteoid osteoma is solved only, without treatment, after several years. Because of this, if we tolerate well and control the pain with medication, a good option is to leave it alone and do nothing invasive.
Sometimes pain will limit the life of the sufferer. It is these cases you can pose a solution with surgery. The operation would seek to extirpate especially the area of the tumor that produces the prostaglandins (the nidus). With this we remove the pain. The problem with surgery is that you weaken the bone by removing the tumor and may not even be possible if there are vital structures near the osteoid osteoma. In the spine surgery is usually opted for when there are neurological complications and not just a pain problem.
There are intermediate options when the tumor is in delicate areas with vital structures around it. Radiofrequency can be performed on the nidus. This is done by puncturing with a needle that is carried to the nucleus of the tumor. Radiofrequency destroys the tumor by heat. This technique can destroy some bone around so you need to be careful about the entire first month performed technique.