Conservative surgery for osteoid osteoma of the lumbar vertebrae
A 20-year-old male presented with localized low back pain of 2 years duration, attributed to lifting a heavy object. Pain was persistent, worse at night, unrelated to activity, but characteristically relieved promptly with NSAIDS. He was misdiagnosed for over a year, and prescribed physiotherapy, analgesic/antiinflammatory therapy, and trycyclic antidepressants without improvement. On presentation he exhibited mild scoliosis, negative straight-leg-raise test and no focal neurological deficit. Plain X-rays of lumbosacral spine were normal, but the radioisotope bone scan (Tc-99m) showed increased uptake in left posterior half of the L2 vertebra. The CT scan confirmed that the L2 lesion was sclerotic with a lucent focus in the left postero-inferior quadrant []. Surgery, performed in the right lateral decubitus position utilizing an anterior retroperitoneal approach to the L2/L3 intervertebral space (X-ray confirmed) allowed for en-bloc resection of the involved quadrant of the L2 vertebral body while preserving the end-plates and posterior vertebral border []. Reconstruction of the bony defect was accomplished by impacting custom-sized tricortical bone graft harvested from the iliac crest []; no additional fusion was required. Postoperatively the patient was allowed to ambulate freely.\nAt 2-weeks postoperative follow-up the patient reported complete relief of his long-standing pain. At 12 postoperative weeks, the X-rays documented full incorporation of the bone graft []. In his last follow-up at 9 years, he was completely pain-free and had full function of the spine.