Conservative surgery for osteoid osteoma of the lumbar vertebrae
A 16-year-old male presented with persistent localized lower lumbar pain of 2 years duration. Pain was progressive, occurred at rest and at night, was relentless, was increased by walking, and immediately although transiently relieved with NSAIDS. He had been labeled neurotic and given antidepressants. On examination, he exhibited a mild postural scoliosis in the lumbar spine concave to the right, but had no focal neurological deficit and negative straight-leg-raise test. Radioisotope bone scan showed increased uptake over the right side of L2 vertebra on posterior view [] corresponding to X-ray showing a vague halo over the right neural arch of L2 []. High resolution CT scan confirmed a dense nidus and circular halo involving the right lamina []. Surgery, performed prone, consisted of removal of the right lamina utilizing a 3 mm high-speed burr. Careful preservation of the pars interarticularis, inferior articular process, and the facet joint [] avoided instability and the need for a fusion. The patient experienced a dramatic reduction in pain within one postoperative week. The patient was asymptomatic 5 years later. The histopathology confirmed an osteoid osteoma.