Osteoid osteoma is a painful benign bone lesion most often seen in the adolescent age group. The lesion consists of osteoblastic or growing cell mass called a nidus surrounded by a zone of sclerotic but normal bone. The lesion is generally small and often less than 2 cm in diameter.
Osteoid osteoma accounting for 5% of all primary bone tumors and is a tumor of children and young adults.
It is seen mostly in the age of 10-30 years. It is quite rare after the age of 50 years.
The cases have been reported in children less than one year to 70 years old.
Men are affected about 3 times more than females. There is no racial predilection.
Common Sites of Osteoid Osteoma
Osteoid osteoma can occur anywhere in the body. It can involve a single bone or multiple bones.
The cortex of the shafts of long bones is affected in 80-90% of cases. It is also reported in the epiphyseal and metaphyseal regions.
Juxta-articular lesions are rare and seen in the elbow, hip, and ankle joints.
Subperiosteal osteoid osteoma is a relatively rare lesion. The lesion is large because the restricting compressive force on side of periosteum is not there.
Extremity
More than half of the cases are seen in the lower extremity. The proximal femur is the most common site followed by tibial diaphysis. The lesion is usually cortical.
The femoral neck is the single most frequent anatomic site.
Fibular lesions are very rare.
In the upper limbs, the distal humerus is the most frequently involved bone.
Spine
The spine is affected in 10-15% of cases. The majority of the lesions are seen in the posterior elements.
The thoracic region is most commonly involved followed by lumbar and sacral. The cervical region is least commonly involved.
Scoliosis may occur. The lesion is usually found on the concave side.
Articular facets, pedicles, the transverse and spinous processes.
A primary tumor in the vertebral body is extremely rare.
Hand and Foot
The hand is affected more than the foot. Commonly affected bones are scaphoid and proximal phalanges in the hand and talar neck in the foot.
Pathophysiology of Osteoid Osteoma
The nidus is the central nodule of woven bone and osteoid with osteoblastic rimming. It is surrounded by a reactive zone which is an area of the thickened bone and fibrovascular tissue. The consistency of nidus is variable from soft vascular to friable and granular to densely sclerotic.
Microscopically, the nidus is typically composed of a mass of irregular lacelike osteoid tissues in a highly vascular stroma of connective tissue containing osteoblastic cells.
The nidus is responsible for the pain of the osteoid osteoma. Surrounding sclerosis and nerve endings in reactive fibrous tissue also contribute to the pain.
Chemically, the pain is attributed to the increased local concentration of prostaglandin E2 and COX1 & 2 [That is why osteoid osteoma responds to NSAIDs very well.]. There is also an increased number and size of unmyelinated fibers within the nidus.
The presence of osteoid osteoma can be associated with some conditions which could result as a result of the lesion
- Painful scoliosis in spine osteoid osteoma
- Growth disturbance
- Flexion contractures
Clinical Presentation
Constant dull pain which is often progressive is the main presenting complaint. The pain is worse at night and often decreases in the morning.
About a third of the patients report awakening in the night due to the pain.
The pain may also worsen after drinking alcohol [alcohol is a vasodilator]
The pain is known to be typically and dramatically relieved by nonsteroidal anti-inflammatory agents
The hand lesions may not have pain and just have swelling.
There could be additional symptoms depending on the site of the lesion such as
- Scoliosis and/or radicular pain in the spine.
- Growth disturbances in the lesions near the epiphysis of the long bone
- Joint pain and swelling when lesion is near the joint
- In lower limb lesions, limp may occur
- Small bone lesions may cause bone expansion leading to enlargement of the digit [macrodactyly]
On examination, the involved region may or may not have swelling or deformity. The site is tender in more than half of the patients.
In lesions near joint, joint effusion and contractures may be observed. In intracapsular lesions, the synovial swelling could be present.
Lab Studies
Routine Tests usually show normal findings.
Imaging
X-rays
Initial x-rays are mostly normal as the changes appear on x-ray quite late.
AP and lateral views are standard. Some authors also add an oblique view to that list.
Over the time, serial x-rays should be done to document bony changes occurring.
The x-rays show a well-demarcated lytic lesion (nidus) surrounded by a distinct zone of sclerosis.
The nidus may show a zone of central opacity [sclerosis].
Spine lesions often so not show nidus and may show just sclerosis.
In small bones, bone expansion is notable.
An intraarticular lesion may lead to decrease in bone density around the joint.
Premature fusion of the epihysis can occur when the lesion is closer to the epiphysis. But it is rare.
CT
CT precisely localizes and identify the nidus. It is the investigation of choice in osteoid osteoma and can tell the extent of bony involvement.
CT is indicated in the following situations
- Nidus not visible on x-rays
- Residual or recurrent tumor
- Lesion at the critical sites like the spine or femoral neck
On CT, osteoid osteoma appears as a circumscribed annular lesion with a double-attenuating sign [lesion within a lesion]
MRI
MRI has not been useful in the diagnosis of osteoid osteoma.
MRI is sensitive in detecting peritumoral edema, and soft-tissue abnormalities. It is not done mostly as it can mimic more aggressive lesions.
Radionuclide scanning
It is done when the diagnosis cannot be made with certainty especially in children.
It shows nidus as the hot area of focal uptake. There is low uptake in the reactive zone. The sign is known as the ‘double-density sign’
It is also able to diagnose multiple bone involvement.
The investigation as 100% sensitive [picks up all cases of osteoid osteoma] and 100% specificity [ no negative bone-scan findings have been reported in patients with osteoid osteoma]
Differential Diagnoses of Osteoid Osteoma
- Chronic and acute osteomyelitis
- Bone abscess
- Intracortical hemangioma
- Bone island
- Stress fracture
- Ewing’s sarcoma
- Intracortical osteosarcoma
- Aneurysmal bone cyst of spine
- Osteoblastoma of spine
Osteoid Osteoma Treatment
Non-steroidal anti-inflammatory drugs are first line of treatment and often cause dramatic relief of symptoms.
More than half of the patients can be treated with NSAIDs and observation over a period.
Distal tip lesions of the fingers usually do not respond to the NSAIDs.
The pain from the lesions is known to resolve after an average of 3 years and the lesions in about 5-7 years.
But in patients whose pain do not respond to NSAIDs or have secondary issues like deformity [scoliosis in spine] and/or have risk of complications like stress fractures, growth disturbances, early surgery may be considered.
Surgical Treatment
Surgery aims to remove the nidus completely.
Percutaneous Radiofrequency Ablation
Percutaneous radiofrequency ablation involves introducing a thermal probe in the lesion and destroying the lesion. This procedure is indicated in
- When the non-operative management has failed
- Lesions near the joints [surgical removal can injure the cartilage
- ion of failure of medical management periarticular lesions, which increases the risk of cartilage injury
- Selected spinal lesions away from neural tissues
- Lesions close to spinal cord or nerve roots are contraindicated as heat can injure the tissue
Patients may require more than one sitting. 90% of patients are successfully treated with 1-2 sessions.
A recurrence rate of 10-15% has been reported.
Here is a short video on the procedure
Surgical Deroofing and Curettage
In this procedure, overlying bone is removed and the tumor is excised excision with curettes and burrs.
The procedure is chosen when radiofrequency ablation cannot be done due to the site of the lesion i.e. close to skin or nerves or spinal cord.
Spine lesion with painful scoliosis is also a candidate as ablation cannot be done.
En bloc resection
This consists of resection of the lesion totally with a rim of normal bone. The procedure cannot be done in areas that are difficult to reach.
The procedure is contraindicated in patients with lesions in areas difficult to access such as the acetabulum or femoral head and neck.
The drawbacks of this procedure are longer healing times, fractures in the perioperative period, need for bone grafting and internal fixation, joint stiffness etc.
CT Guided Percutaneous Excision
In this method, under CT guidance, a needle is inserted in the nidus. This reduces the amount of bone removed during surgery. Postoperative CT scan and pathologic examination are done for the confirmation.
Percutaneous Laser Photocoagulation
An optical fiber or fibers are inserted directly into the target tissue, followed by treatment with laser energy for several minutes.
Recurrence
The reported recurrence rate after open surgery is 9-28%.
Recurrence is typically observed within 1 year after excision.
References
- J. Simm.The natural history of osteoid osteoma. Australian and New Zealand Journal of Surgery, vol. 45, no. 4, pp. 412–415, 1975.
- S. Kneisl and M. A. Simon. Medical management compared with operative treatment for osteoid-osteoma. Journal of Bone and Joint Surgery—Series A, vol. 74, no. 2, pp. 179–185, 1992.
- Greenspan A. Benign bone-forming lesions: osteoma, osteoid osteoma, and osteoblastoma. Clinical, imaging, pathologic, and differential considerations. Skeletal Radiol. 1993 Oct. 22(7):485-500.
- Burn SC, Ansorge O, Zeller R, Drake JM. Management of osteoblastoma and osteoid osteoma of the spine in childhood. J Neurosurg Pediatr. 2009 Nov. 4(5):434-8.
- Frassica FJ, Waltrip RL, Sponseller PD, et al. Clinicopathologic features and treatment of osteoid osteoma and osteoblastoma in children and adolescents. Orthop Clin North Am. 1996 Jul. 27(3):559-74.
- Donkol RH, Al-Nammi A, Moghazi K. Efficacy of percutaneous radiofrequency ablation of osteoid osteoma in children. Pediatr Radiol. 2008 Feb. 38(2):180-5.
- Burger IM, McCarthy EF. Phalangeal osteoid osteomas in the hand: a diagnostic problem. Clin Orthop. 2004 Oct. 427:198-203.
- Swee RG, McLeod RA, Beabout JW. Osteoid osteoma. Detection, diagnosis, and localization. Radiology. 1979 Jan. 130(1):117-23.
- Israeli A, Zwas ST, Horoszowski H, Farine I. Use of radionuclide method in preoperative and intraoperative diagnosis of osteoid osteoma of the spine. Case report. Clin Orthop Relat Res. 1983 May. 194-6.
- Donahue F, Ahmad A, Mnaymneh W, Pevsner NH. Osteoid osteoma. Computed tomography guided percutaneous excision. Clin Orthop Relat Res. 1999 Sep. 191-6.
- Engel EE, Gava NF, Nogueira-Barbosa NF, Botter FA. CT-guided percutaneous drilling is a safe and reliable method of treating osteoid osteomas. Springerplus. 2013 Dec. 2(1):34.
- Raux S, Abelin-Genevois K, Canterino I, Chotel F, Kohler R. Osteoid osteoma of the proximal femur: treatment by percutaneous bone resection and drilling (PBRD). A report of 44 cases. Orthop Traumatol Surg Res. 2014 Oct. 100(6):641-5.
- Bown SG. Phototherapy in tumors. World J Surg. 1983 Nov. 7(6):700-9.
- Gangi A, Gasser B, De Unamuno S, Fogarrassy E, Fuchs C, Siffert P. New Trends in Interstitial Laser Photocoagulation of Bones. Semin Musculoskelet Radiol. 1997. 1(2):331-338.
- Volkmer D, Sichlau M, Rapp TB. The use of radiofrequency ablation in the treatment of musculoskeletal tumors. J Am Acad Orthop Surg. 2009 Dec. 17(12):737-43.
- Powell MF, DiNobile D, Reddy AS. C-arm fluoroscopic cone beam CT for guidance of minimally invasive spine interventions. Pain Physician. 2010 Jan. 13(1):51-9.
- Image Credits
- CT Osteoid Osteoma – Case courtesy of Dr Maulik S Patel, Radiopaedia.org. From the case rID: 10262
- Osteoid Osteoma of Femur – Case courtesy of Dr Angela Byrne, Radiopaedia.org. From the case rID: 7592
13 old male with medial side thigh pain since 6 to 8 months, pt have pain off and on,pain more in nigth, nasid relifed pain , but last 2 mo pian was continue in nigth and morning , xray shoe medial side sclerosis leison near LT, serum alk po4 234. s ca 8.3, other inv normal limit,
Hi
my father in law is about 60 years old he is suffering from Osteoid Osteoma with so much pain. please tell me what can we do for treatment of this disease.
thanking you
ARADHANA
@aradhana,
Did you go through the article. I think the article covers the outline of the treatment well.
If yu want to inquire further please let me know.
@sachin,
MRI?
CT?
ESR?
I suffered from an Osteoid Osteoma on the end of my femur within the hip joint. The pain was unbelievable , especially at night. Surgery would have required a lengthy recovery. I searched all over the internet to find an alternative. Ultimately I discovered that Radiofrequency Ablation was being done at Mass General. I pursued this option and I have been pain free ever since. It was an outpatient procedure and I actually walked out of the Hospital under my own power!
This was 7 years ago and I remain grateful that this option was available.
I searched this topic today out of curiosity to see if there have been any improvements to the availability of this option for treatment and I am disappointed that it is not referenced in more widely available information. Its a shame. It makes me wonder what other medical options have been developed and still remain a virtual "secret"
@Jeffrey Spalt,
There is no secret. Things happen painstakingly slowly when the treatment aspect is a concern.
Good to know it worked for you.
Hi,
I am 26, generally fit and healthy. I was playing basketball and pulled back my middle finger, ring finger and baby finger. At the [email protected], they said I fractured my 4th metacarpal, was referred to fracture clinic who then said no fracture but an osteoid osteoma. This is quite painful and a very slow process and the waiting is ridiculous! I'm being referred for an MRI, is this normal? Also can an osteoma be caused by trauma?
Thanks in advance, Joy.
@Joy,
Trauma results in tissue injury. Osteoma is a kind of tumor. Both are entirely different.
Has MRI been done. Can you send me the xray and MRI pictures to contact [at] boneandspine dot com
Dear Sir/Madam,
I am 39years old.Long time back i got pain by heating heavy iron stick.Now i have continious pain on my right thigh middle shaft.Night time it is giving more pain and i went to doctor and did CT Scan,MRI,And X-ray,they are telling it is an osteod osteoma.I did an RFA but still have same pain.My question is it possible to occure this osteod osteoma by heating something?.they are telling i have to do same RFA again.Am I now right way to my treatment?What i can do please tell me.
Thanks
Santo
@Santo,
Yes! Your treatment appears on the right line. If RFA des not work another option is removal by surgery.
I was recently diagnosed with an atypical osteoid osteoma in my lower femur (there was no nidus present). My ortho oncologist plans on following me for a while to see what happens. The pain was horrible before my biopsy. I had a wide excisional biopsy to rule out chondrosarcoma. The pain after the surgery was much better, after recovering from the surgery itself which was aweful. I still hurt at times, but nothing like it was before. NSAIDs seem to work pretty good.
Dear Doc,
Recently my wife was diagnosed to be suffering from osteod osteoma in hip joint area & also with vitamin D defficiency. She is having trouble walking. Pl suggest what should we do & which is the ideal place for treatment. Is the problem permanently curable by surgery or RFA.Pl help with your suggestions
I have a small bone growth in my forehead. I cannot find any surgeon to remove it.Please help
@Diana,
Please ask your local health care provider
@Chris,
Good to here that you were relieved of the ailment.
@rajesh,
Both surgery and RFA are effective. The best place of treatment would a center with experience in musculoskeletal cancer surgeries.
Hey,
I have being suffering with a ankle problem for 7 years, I've had 4 MRI scans, many X-rays& key hole surgery as well as many sessions with a physio therapist. After my 4th MRI scan they now suspect I have osteod osteoma. It is possible to be suffering with this for 7 years? I have researched all the symptoms and I have had most of them. If I do have osteod osteoma and it's been going on for this long could it be more difficult to cure?
I look forward to you reply
Many thanks
Erin
@Erin lewis,
Osteoid osteoma needs either surgery or ablation. Did you discuss it with your treating doctor.
Dear Sir/Madam,
My son is being diagnosed having osteoid osteoma in his right leg just below the knee joint, he is 6 yrs old, he is being given vitamins and pain killers and under observation for next 15 months. My wife and parents are suggesting to go ayurvedic treatment in sri lanka. Please tell me what is the best possible treatment, will he suffer in the long run, he is only 6 years, what would be his future?? please help
Thank you very much.
@B K Perera,
I cannot comment on Ayurvedic treatment. Osteoid osteomas are known to resolve spontaneosly and that is why you might been asked to wait while your child is put on symptomatic treatment.
Best thing now is to wait.
Dear doctor..
i am having pain in my right knew from last 3 weeks..it occurs mostly in the night and the pain is very strong.. i had my knee surgry done about 4 years ago and the bone tumer was removed with the lazor in orthopedic hospital….i have been to my doctor and he adviced me to take asprine..and if the treatment is done once.. why does it come back again ??
Hello
am 25 years old male
i have diagnosed with osteoid osteoma in the lower quarter of the femur
i dont want to do the surgery
and thereis not ablation in my country
could i stay like that
if there is just a little pain wich i can bare
please give me the ansower
Dear Dr.Singh- My son who is now almost 14 is going through his second bout with an O.O. that initially occured in the L5-S1 juncture. He is experiencing unbelievable pain that predictably worsens even more @ night. The first time this tumor occured it took over 4 months of tests & misleading diagnosis (he had developed a 7degree scoliosis of the spine) & went through a nightmare of being told by 2 MD's that he should not be in the amount of pain that he was reporting. Thankfully we were seen by Dr. Frank Gerow, MD who was able to diagnose my son with 1 examination & a thin-slice CT of the area.(Tx.Children's Hosp.,Houston, Tx.) It took another 2 months to find an Interventional Radiologist who was willing & able to do the RF ablation procedure in Feb.2010. My son was pain free til the recurrance in the last 2 mo. We are awaiting a surgical date for the 2nd RF ablation. Due to my son's age, it seems doctors have been reluctant to treat his pain & anxiety appropriately until surgery. (He is 5'6" & now weighs 180# due to his inability to be mobile.) Thank you for putting good info out for research. Do you think that this tumor will keep recurring?
@fuad,
Most of them spontaneously resolve. You might want to wait if you could bear the discomfort or manage with symptomatic treatment.
@RAY,
What tumor was removed?
Osteoid osteoma?
@Niki W.,
Recurrence can occur and usually the second procedure provides complete cure.
If still it recurs, the tumor should be removed surgically.
All the best.
my son is suffering from osteoid osteoma neck of femur (Lt -intra articular) from 2005. the size is around 1cm. Initially he had lot of pain. Now no pain. As per the latest CT the size is same. He plays bascketball and can run for long distance (5 Km). What should we do. I want to know that this OO remains benign or it becomes malignant?. If it gets cured on its own than after how many years approx. Since physical excision is complicated in this case, for RF ablation also requires drilling through bones or what?. If yes than how much time required to heal. I eagerly waiting for the reply. Thank you.
@vageesan R,
Would you please ask your query at http://boneandspine.net
That way we can discuss over a longer period of time, and discuss all the options and concerns.
I was diagnosed with this osteoma on the side of my skull. The hospital consultant said it was nothing to worry about and removal would only be cosmetic and shaving some of my long hair off. He said, if it wasn't causing any pain, not to worry about it. I have read that osteoma is benign. But that could change to malignant right??
Yes! But then risk is with every living cell. Just watch it and if there is a pain or sudden increase in the size, seek consultation. Otherwise be in regular followup with your doctor.
I was suffered from Osteoid Osteoma for which I had undergone a surgery in april 2011,but their is no relief from pain,again I have repeated CT & MRI scan last week,but nidus was not seen in it,now what to do? Are their any other tests?Whether I should prefer RFA? if yes then please mention me best centre of RFA in India which should also be cost effective to me,and whether mediclaim can be received against RFA. Please suggest….
@Manoj,
If the nidus has been removed, I do not think there is need to worry.
But as the area involves the skull please consult your doctor if RFA is applicable to that part.
I would look at info on RFA centers in India and would let you know.
I had a bone swolen on d lower part of my left leg b4 d ankle since 1996, almost 16yrs. which i dont count it as anything, until lately wen it startd increasing up to lime size and just last week i went for an x-ray and they detected oestoid oestoma. Pls doctor, since the pain is not severe, can my takin aspirin only everyday bring total cure? Wat else can i use that wil melt the growth or that wil make it com back to normal. Tanx
@Adey,
Osteoid osteomas are known to remit with time. Just keep a watch and take symptomatic medication for few years if it is possible.
My nephew is 17. He have been in pain on and off for 4month, CT telling he had a 4mm Osteoid Osteoma in the neck of his left femur. He would like to go through the operation to remove the tumor in order to get rid of the pain. He is busying in basketball training. How long is it going to put him in bed after the operation if it is successful? thank you.
Hi! i have had osteoid osteoma for three years. My only suggestion is that if your a parent and you care about your child's health and happiness you will get a surgery as soon as possible. Waiting it out is a painful experience and i understand that you may be in a tough financial situation but there are options you should explore before settling with waiting it out.
Hi! Friends , I was suffered from osteoid osteoma in my tibia,for which I undergone a surgery which was unsuccessful,then I opted CT Guided RFA (radio frequency ablation) to cure this last month,which was successful,now I am painless and having good sleep.
I suggest all the patients to opt CT guided RFA,which is short and painless procedure.
hi,
i am suffering frm oseoid osteoma from about 1 year.at first i was not knowing about this.and then after somedays it started paining.i went through x ray of my right hand radius …but in x ray it didnt showed clearly ..aftr the suggestion of a doctor i went through a mri…….and the mri report stated that i having tumor but then i went through fnac test and came 2 know that its not tumor…..aftr that i went for a bone scan test in which i came to know that its osteoid oestoma…doctors told me that i have 2 go through a surgery…bt as i in military feild so i am looking for a beeter treatment rathar than surgery…i am also havinh some homeopathic medicine…bt no improvement is till now seen…plz suggest me some beeter treatement.
Hello Doctor,
I am suffering from OO. Its been over 2 years now and just 2 months back when it got detected, I am doing certain exercises to get over the tumor.
I had a doubt regarding this, can the tumor be cured naturally?I mean without doing anything or by doing any exercises.
P.S. The exercises have been mentioned by a doctor (a specialist)
Thanks
My son was diagnosed with an osteoid osteoma on the anterior face of the sacrum, one on the base [top ] on the right side and one in the first foramen of the sacrum. Thermal ablation worked for the one on the base, but doctors at Texas Children's Hospital refuse to do ablation or surgery for the one on the first foramen because of the spinal nerves tracking through that opening. The first diagnosis was at age 11, now he's 16 and has significant pain at night, especially when we get a cold front. Use of NSAIDS has given him terrible gastro-intestinal problems [he's currently bleeding internally and in process of being treated for ulcers]. Do you have any advice for treatment or removal?
I'm feeling very anxious about his future. Do osteoid osteomas burn themselves out? Should we investigate RF ablation? Is it any safer than thermal ablation?
Help! Thanks!
Hi, I am 18 years old and I have osteoid osteoma in my thigh and it causes severe pain in my foot and calf. I have had it since I was a child and it reoccurs every 6 months or so. It is so severe it gets me out of bed and nothing relieves the pain. It brings me to tears and I have a relatively high pain tolerance. What should I do??
@Ruth,
Osteoid osteomas are known to regress with time but the may not occur in all the cases.
I think sufficient time has passed to wait for regression.
Surgical removal is another option which can be considered.
@hiren,
OO resolves in some cases with time. If it is not troublesome, you may opt for wait and watch.
@Lucia,
It would depend on the size of lesion and sugery done. Because it is a wt bearing joint I expect 6-8 weeks of rest. But ultimate answer would be given by your treating doctor.
i recently had a sergical operation for the treatment of osteiod ostema but my night pain are back after i had sergical operation i had relief for 15 days but at 16th day my pain are back mr.dr i want to know that does osteiod ostema reappear after sergical operation if not why my night pain are back but pain last for short hour before operation.
hi,
i am a 17 year old boy and i am suffering from osteoid oestoma in my right hand's ulna from 2 years …earlier i was not knowing about this but once it started pain and then got my x-ray done but nothing was clear from that and then with the reccomendation of an orthopaedic i got my m.r.i and bone scan done…..and the m.r.i report stated that i am having bone tumor but the report was wrong when i got my F.N.A.C test done…plz suggest me some treatment irrespective of operation or surgery……
Hi Dr. my leg was hurting me i made an x ray and CT some doctors told me it is a osteoid osteoma and some told me it is not am confused and i don't know if i have to make an operation or not kindly help me.
I am kishor from pune
since last 3 months i have pain in my hip joint
in MRI and CT scan
i founf that osteoid osteoma is there
surgery is critical for removal of osteoid osteoma doctor said joint has to be dislocate so it is risky
i got info about RF it is easy way than surgery
can i do RF ablation
help me plzzzz…
I am kishor from pune
since last 3 months i have pain in my hip joint
in MRI and CT scan
i founf that osteoid osteoma is there
surgery is critical for removal of osteoid osteoma doctor said joint has to be dislocate so it is risky
i got info about RF it is easy way than surgery
can i do RF ablation
help me plzzzz…
@aditya,
There are only following options available
1. Wait and watch while you take medicines to kill your symptoms. Quite few of the OOs disappear after few years
2. Surgery
3. Radiofrequency ablation
You can talk to your doctor about each for yout particular case context
@Ashley Geiser,
Osteoid osteoma is treatable. What has your doctor suggested?
I have a 1cm osteoid osteoma on my femur. My doctor suggested that only surgery is an option and RFA is not a solution. Could you recommend any hospital or surgeons providing RFA in Bangalore.
Thanks
Reshma
@Danial,
First thing is to be sure as what the condition is. You may seek another opinion. biopsy and so on. One cannot contemplate surgery without a definitive diagnosis.
@aditya,
Osteoid osteoma is a bone tumor. What was declared wrong in FNAC..
@sujan bhusal,
Usually not if the nidus has been removed.
How are you now?
@kishor,
it would depend on site and size of the lesion.
@Reshma,
I am sorry I am not aware of centers in Banglore. A search with local medical community would help.
hi i m gurpreet i was having pain in my right hip joint doctor advised me to get X ray done. In X ray report a small lytic lesion was detected in my one third proximal of my right femur. subsequently MRI CT and Bone scan was done but ailment is not diagnosed yet. my all reports indicates lytic lesion of 2cm in size in diaphysis of my right femur . it is eccentrically located and is epicentred predominantly in intra meduallary region with cortical extension causing thinning and breach of cortex(as in MRI report). after that biospy was done twice , bone tissue processed was non representative of any neopathlogy evidence. plz suggest me right path.
hello sir i m Gurpreet Singh i was having pain in my right hip joint doctor advised me
to get X ray done. In X ray report a
small lytic lesion was detected in my
one third proximal of my right femur.
subsequently MRI CT and Bone scan
was done but ailment is not
diagnosed yet. my all reports
indicates lytic lesion of 2cm in size in
diaphysis of my right femur . it is
eccentrically located and is epicentred
predominantly in intra meduallary
region with cortical extension causing
thinning and breach of cortex(as in
MRI report). after that biospy was
done twice , bone tissue processed
was non representative of any
neopathlogy evidence. plz suggest me
right path.
sir my bro is suffering from this in rip hip femur . plz tell me what we do . its size is 8.8 mm . . . plz send me your email address
I went for a second opinion and the doctor diagnosed it as bone island. Since I have mild pain near the hip joint he wants to wait for a few months and if the pain is more to remove it. As bone islands are generally not supposed to be painful, is there instances of them causing pain and is the surgical removal only option available ?
Thanks
Reshma
@gurpreet singh,
If it is a benign lesion as you suggest, curettage and bone graft is one the methods to be considered. That way whole tissue can also be removed for examination.
Hello, I was diagnosed with an Osteoid Osteoma on my right thigh bone in 2009 when I was 25, and suffered a few times a week. The pain was bad, but motrin or advil always did the trick. My Dr said that most burn out within 24 months, and last year, I noticed the pain was gone. I was so relieved. I am now 18 weeks pregnant with my 1st child, and have been having DAILY O.O. pain since about 6 or 7 weeks. I have been taking Tylenol but hate to do that on a daily basis. The pain now seems to "spread" to my knee, and while Tylenol works, I dont want to be dependent on it. I refused to have an x-ray or surgery while pregnant, but will definitely look into treatment after the birth of my child. My question is…does pregnancy tend to cause an O.O. to come back? I believe mine was gone, or almost gone, and now it seems like its back, with a vengeance! Thanks so much.
I was fist diagnosed with osteoid osteoma some 5years back, when my daughter was born, when she was diagnosed with a large PDA, i totally forgot my pain, looking at the pain suffered by my daughter, looks like the pain has recurred, i dont want to get into surgery, as i am self employed and running, taking care will be a difficult one. Can i get some non-surgical treatment available in bangalore, can this be covered under insurance. Too much of pain killers are also a scary, as i underwent surgery for kidney stone 2 yrs back. I am 40years old.
Hie i am 26 years old in Zimbabwe & was diagnised with osteoid osteoma on the middle of the femur. My doctor however advised me not to take any treatment. Is this safe. The pain is not increasing.
@gurpreet singh,
Was it a open biposy or through a needle?
@Talha Jamal,
contact [at] boneandspine.com
@Happiness,
Every procedure does carry a risk and you need to discuss it beforehand if there is any concern about complication etc.
@Reshma,
Bony islands are not painful in general sense but some of them have been known to cause discomfort after exertion.
If your second diagnosis is right, all you need is symptomatic treatment. But make sure your diagnosis is right.
@Annie,
I do not think there is a known relation between the two.
How are you now?
Hello Dr., I am 43 years old, underwent total abdominal hysterectomy 1 year ago.. My CT scan result states that Multiple axial tomographic sections of the right tibia were obtained without contrast. There is a small, round, well-circumscribed, lesion eccentrically located within the medulla of the proximal tibia with a central hypoechoic nidus and a thick sclerotic rim. It measures 1.2 x 1.1 x 0.9 cms. (LxWxD). The surrounding bony parenchyma is intact with no surrounding reaction noted. Conclusion was OSTEOID OSTEOMA, PROXIMAL TIBIA, RIGHT… The Dr. advice me to take Perispa, Osteo D & Arcoxin and to have follow-up check-up after 2 weeks for possible biopsy. I can't feel pain when in sitting position but when I stand up, that's the time I feel the pain some part in my right knee.. After taking in the medicine, I can't feel better.. May I ask if there a medicine or alternative not to have surgery? Please help me.. Thanks for this site
Radiofrequency ablation is another option. Whether it is available in your place or not would need to be searched. Coverage by insurance would depend on type of insurance you have.
Osteoid osteomas can go on their own in number of cases. You may want to wait while avoiding painful activities, if that does not put you under much stress.
my child also suffer in ostiod osteoma inleft leg shaft. he has sever pain in day two to three time. i consult various ortho surgeom. All surgeon advise me take aspirin in two to three time in day.after three month i asked doctor how many day we used aspirin .what is the useful advise. Doctor advise me surgery.
Osteoid osteomas are known to regress with time. However, if pain is not being relieved or it is affecting activities of daily living, surgery can be considered.
My younger brother developed pain in right leg , above knee joint 18-24 months back and after CT scan/detailed investigation by an orthopedic surgeon , the disease was diagnosed as oestoid osteoma. At present he has been recommended pain killers only and is experiencing severe pain almost regularly.
We have been told that the only possible permanent treatment is surgery but after some research on internet, i have read that treatment for this Bone Tumor(oestoid osteoma) also exists through RF ablation which is safer and is considered more successful mean of treatment.
We are confused that should we opt for surgery at the first place or prefer RF ablation first ?
also if the treatment facility for its cure through radio frequency ablation exists in Pakistan or where else can we get the treatment.
Thankyou
Where i s the tumor located?
I am a very active 19yr old. I run alot and I’ve been in pain for about 8 months. however because of my jobI’ve had to take painkillers for it and keep it moving. It was only about a month ago, after an X-ray and CT Scan, the dr.s found a osteoid osteoma in my left femur. After seeing an Orthopedic specialist I was told that my only option was surgery. He stated that it is a considerable size and I was wondering if a radio frequency ablation was no longer an option because of its size or is the size of the tumor irrelevant?
Clinical record and images please
I am a 13 year old girl with symptoms of the condition
X ray verified and nighttime pain and Nocturnal leg cramps knee
Electromagnetic therapy without surgery is it safe?
What is the site of the lesion?
I have been suffering from multiple osteomas in my skull, cheek bones, mouth and jaw and have so far had surgery to remove them 8 times and they just keep growing back faster and more painful every time, I have been told my condition is unique and they don’t really know what else to do, there has been some talk of some sort of course of injections to try and slow them down but that’s about it.
I was diagnosed O O , still there is pain, advised repeat RFA by My Dr. Kindly advise me who is the most experienced Dr who will treat OO by RFA in India .
It is better to ask your treating doctor.
Hello Dr. My Grandson had his osteo ostomas taken out surgically in his lower leg when he was three. It came back and they removed it again when he was 8. It’s been 9 months and under where the tumor was by the ankle his leg is swollen. He walks different, foot turned slightly out since surgery and now sometimes when putting it in water he screams saying it hurts. Any ideas??
Christina,
You would need to put in more info, enough to make deductions. Exact location, xrays, previous and fresh and other documents if you have. try providing me as much info as you have for a better answer to your query.
Arun
Hello! I just left VCU in Richmond. They told me that the bony tumor on my jaw is most likely an osteoma based on xray and ct scan. I was wondering…how can they be certain the tumor is a benign osteoma without doing a biopsy? The lump has grown larger over the last few months and is causing pressure on the lower mandible. VCU has consulted with my ENT and Oral Surgeon back home and they want to “watch and wait” for 3 months. Is this a common approach without conducting a biopsy?
Leann,
Final confirmation of any lesion is through histopathological examination of the specimen [biopsy in other words]. Xray and CT can tell and indicate but to be certain, biposy examination is done. This is standard practice. In case of malignancies, it must be done.
Take care.
Hello, I believe my 14 year old has OO in her left hip that causes pain in her left leg at night. She takes Advil and the pain goes away. She plays basketball and it doesn’t bother her very much while playing. We see the doctor tomorrow for diagnosis confirmation after doing an MRI w/ contrast and CAT scan. If it happens to be OO, should she continue her basketball activity and take Advil at night if the pain develops? Considering the fact that some OO goes away on its own. Thanks
LAPD26287,
I would let your treating doctor decide that for you as he/she is much more equipped with the info required to answer your question. Size, site and behavior of lesion are important parameters to consider.
Dear sir
I have bony growth swelling on my upper molar teeth. I have checked with Maxofacial sergion, he said me that this is osteod osteoma benign. I have no pain or any other symptoms but only bone growth. He said me that no need for biopsy or surgery.
After 6 month I rechecked again. The Growth was not increase in remain same.
He again reply me that no need for worry this is simple upper palatal alveolar bony growth.
Give me ur expert opinion about this.
This problems falls out of my domain. I am sorry that I would not be able to help.
Hello sir,
I’m a guy, 35 years old. During the summer 2015 I did a serious kayak trip (~ 2400km) and after that I have pain in my right hip, often during the day and always in bed when laying in certain positions. The kayak trip took 3 months and meant a lot of sitting, some days up to 15h non-stop. I have never experienced pain in the area before the trip.
After more than one year with pain, advices from physio therapists and stretching I contacted the doctor. I have done X-ray, MRI and CT last couple of month. Today my doctor called me and told I have OO in the upper part of the femur (near the psoas attachment point).
Do you think the kayak trip has triggered the body to develop OO or is it maybe just a coincidence?
I’m an active guy and I have always felt that stretching helps, especially the psoas. The pain always get worse during activity, and lasts a couple of hours after an exercise. Is this typical for OO? My doctors says I have fluid accumulation in the area and proposes me to do an RFA treatment.
The pain has almost been the same during the last 1-1.5 years and I have learned to live with it. Haven’t tried anti-inflammatory drugs yet.
You seems to be an expert in the area, what is your advice for me? Can it get worse if I don’t treat it?
Many questions, hope you can give some advice!:) Thanks in advance!
Ivan,
The trip would not cause the lesion but could have caused the symptoms to get that noticed. The symptoms you describe could be due to any lesion and not specific. Your site of lesion is deep and size and behavior of the lesion would guide the treatment.
Either you have a good pain tolerance or another differential needs to be considered as well.
If the size is increasing and jeopardizing the integrity of the site [ affecting bone strength or increasing fracture risk], you should take a decision to undergo surgery.
The best option, if you want to take specific advice, is to take a second opinion in person from a doctor in vicinity.
Take care.
My 12year old daughter had O-o on her right femur bone and got operated for the same last year, the nidus was removed completely and she had no problem after that. But for the last 3 days she started complaining of pain around the area not exactly on the same place but on right thigh. Is there a chance for recurrence? Can I wait for a week to see whether the pain subsides or not? Please suggest. Thanks
Hema,
Sometimes the pain is due to some different etiology. But your concern is rightly placed and you should rule out that. There should not be an urgency though.
Take care.
Hello Dr Arun Pal,
I am most impressed by your article and your knowledge of Osteoma.
I have been diagnosed with Osteoid Osteoma of the posterior element of the C7 Cervical spine with oedema extending to the pedicle body of C7. the Nidus is partly calcified. My questions are:
Q1- I am not keen on surgery but was wondering if any other intervention can be done considering the risk that it may damage the cervical facet joints.
Q2 – I have had pain for 6 months on an ongoing basis and manage it with anti inflammatory medicines. is there a time frame when the pain usually settles down?
thanks very much in advance.
Abha,
Because it is a critical area, I doubt if any other intervention is without the risk.
These lesions may regress on their own in few cases. Apart from that, the pain usually continues while responding to drugs.
Take care and follow your treating doctor’s advise for the best course of action.
Hi Arun,
I developed this disease 5 years ago. And it still continues to pain every on and off, I tried pain killers but it works for 4-5 days then the pain comes back again. I am 32 years now, and a little afraid of the consequencies of surgery.
Can i work out/ exercise ?
I am a little worried because i have been having pain killers for almost 4 years now.
karan,
If it is there for 4 years, you should consider surgery or other procedure to remove the tumor.
Hello Doctor,
This is Karan again, I consulted a local bone specialist. He insisted as I was taking a painkiller every week once of 90mg is fine. He didn’t recommend me for surgery.
But somehow the thought of having pain killer for more than 4 years frightens me a lot.
Plz suggest !
Technically it should be fine. But lesion needs to be monitored with regular imaging.
Take care.
8 yrs boy with osteoid osteoma.
His body weight is 37 kg
We prefer medical treatment.
May I know correct dosage of aspirin
Aspirin is avoided in children as far as possible. Please try some other NSAID first.
My 17 yr. old son was misdiagnosed for four years with a variety of ailments including hip apophysitis and FAI (femoral acetebular impingement). He underwent surgery last year for FAI in left hip joint. When pain was not relieved by this surgery, they finally discovered an intra-arcticular osteoid osteoma in the left hip joint along the inferior medial femoral neck that was missed in previous mri’s. Doctors suspect that when they shaved the bone for the FAI surgery they may have removed some of the osteoid too, but not all of it. My son’s pain has improved 50% but it still lingers. It especially hurts when he sits in an upright position with a very straight back. We were told position does not matter with an osteoid with regards to pain. We were also told that the osteoid could hurt when a tendon rubs against it or in certain positions since it’s in the hip joint. Which is true? Affected by position or not? Also, there is some femoral neck osteophytes on last scan dated 5/20 and debris in a small amount of joint fluid consistent with synovitis. They noted some irregularity in the femoral head cartilage and acetebular cartilage. We have been told the osteoid is burning itself out due to the length of time it has been present along with my son’s decrease in night pain, and to avoid surgery at this point if my son can tolerate the pain. But we’re wondering if the osteiod is causing the osteophytes and the pain when sitting (or is this post surgery pain?) and if it should be removed. Could the pain when sitting be related to the osteoid? What is your opinion about removal at this point? Thank you for your time and the expertise that you share on this site.
The presence of osteophytes mean an intraarticular pathology [inside the joint]. If your main query is the removal of OO, I think if your doctor suggests that it is burning out, you can wait for a few years to let it go.
That would also answer if OO was responsible for pain you are talking about.
If the child is still having pain then further assessment is to be taken at that point.
Thank you for your response. Much appreciated.
Welcome, Beth!