Ms. D was diagnosed with progressive scoliosis (secondary to the osteoid osteoma) in an immature patient with resolved pain (status post RF ablation). She began nighttime bending-brace treatment and showed improvement with the brace on her return visit two months later. She will be observed for many years and the expectation is that the scoliosis will resolve or halt and she will not need surgical intervention.

3. DISCUSSION

Osteoid osteoma is an osteoblastic bone lesion that is most commonly seen in adolescent males; ranging from 5 to 30 years of age. The male-to-female ratio is approximately 2:1. These benign tumors account for about 10% to 12% of all benign primary bone lesions and 3% of all bone tumors. Jaffe first described the condition in a case series of five patients, aged 11 to 22 years, from 1933 to 1935.1 The lesions were <2 cm in size, composed of osteoblasts, and “roundish, clearly circumscribed and confined within the bone” on radiography.


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Although it is a well-documented bone tumor, osteoid osteoma can be difficult to diagnose because of its unusual features and locations. A number of researchers have reported a delay in diagnosis of up to one to two years.2-5 This delay may be attributable to late onset of radiographic features. As with Ms. D, osteoid osteomas classically present with insidious onset of pain over a localized region. The pain frequently is relieved by nonsteroidal anti-inflammatory drugs (NSAIDs). Night pain is a common entity with these lesions.1 The pain is characterized by intermittent episodes of dullness and achiness, which may or may not progress to intense, sharp, knifelike sensations that can worsen over time and can refer pain to adjacent joints (Ms D’s pain did not progress to the knifelike pain, possibly due to the eventual intervention or her frequent use of NSAIDs.) Physical activity can exacerbate the symptoms.

Osteoid osteomas produce high levels of prostaglandins and cyclooxengenases, causing local inflammatory and vasodilatory responses. They can also cause joint effusions, contractures, or muscle atrophy. The pain is most often relieved by blocking the arachidonic pathway with the use of salicylates.6 Our patient was able to get relief from her pain, albeit temporarily, by taking anti-inflammatory medications. However, there was concern regarding the increase in the amount she was taking.