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Osteoid Osteoma Diagnosis and Treatment

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Osteoid osteoma is a benign [non-cancerous] osteoblastic tumor. It was first described by Bergstrand 1930 but its unique identity was recognized by Jaffe in 1935.

Osteoid osteoma consists of osteoblastic [growing cells] mass called a nidus [very rich in blood supply].

Nidus is surrounded by a zone of sclerotic but otherwise normal bone. It is a reversible secondary change that gradually disappears after the removal of the nidus. The nidus tissue has a limited local growth potential and usually is less than 2 cm in diameter.

Osteoid osteoma accounting for 5% of all primary bone tumors.

Osteoid osteoma is mostly seen 10-30 years of age and about 90% of cases occur in patients younger than 25 years. It has been reported between aged 8 months to 70 years though.

Men are affected more frequently than women and there is no racial predilection.

Pathophysiology of Osteoid Osteoma

Controversy exists whether osteoid osteoma is neoplastic or inflammatory.

Presence of atypical cellular and trabecular components points towards neoplastic nature whereas the small size of the lesion, self-limiting nature and the presence of intracellular viral particles suggest inflammatory nature

The nidus is responsible for the pain of the osteoid osteoma. It is also contributed by surrounding sclerosis and nerve endings in reactive fibrous tissue.

It has been suggested that  radially oriented trabeculae of surrounding reactive bone cause increased pressure in the vascular nidus due to vasodilatation and edema is thought to directly stimulate intraosseous nerve endings to cause pain

Prostaglandins have been linked to osteoid osteoma, some even suggesting a fundamental role in the development.

That is why osteoid osteoma responds to NSAIDs very well.

On histopathological examination, the discrete central nidus is a distinct, well-circumscribed cavity, surrounded by a dense reactive bone of varying thickness. It is cherry-red in color and can be shelled out of the surrounding reactive bone.  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 that in a highly vascular stroma of connective tissue containing osteoblastic cells.

Distribution of Osteoid Osteoma in Body

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 of both small and large bones of the axial and appendicular skeletons, especially the femur, tibia, and humerus.

Extremities

The lower extremities are the most common sites of osteoid osteoma. The femur is the most common bone involved by osteoid osteoma [60% of the cases], followed by tibia.

The femoral neck is the single most frequent anatomic site. The tibia is the second most frequently involved long tubular bone.

Fibular lesions are very rare.

In the upper limbs, the humerus is the most frequently involved bone, and a majority of cases occur around the elbow joint. Involvement of the distal ulna and radius is very rare.

 

Osteoid Osteoma of Femur
Osteoid Osteoma of Femur
CT of Osteoid Osteoma
CT of Osteoid Osteoma

Spine

10 percent to 15 percent of Osteoid osteomas occur in the vertebral column. Most frequently, they are located in the lumbar and lower thoracic portions of the spine.

Spinal lesions are difficult to detect on plain radiographs and are known to be responsible for an unexplained backache and painful scoliosis.

In vertebrae, the nidus is most frequently located in the posterior arch.

Magnetic resonance imaging also may facilitate the identification of an inconspicuous nidus.

Other frequent locations include articular facets and pedicles, the transverse and spinous processes.

A primary tumor in the vertebral body is extremely rare.

Small bones

10 percent of osteoid osteomas occur in the small bones of the hands and feet. The tumor occurs twice more commonly in hands than feet.

In the hands, the phalanges are the most frequently involved sites.

Juxtaarticular

Osteoid osteomas located within the articular capsule are rare. Elbow, hip, and ankle joints are most commonly involved.

Juxtaarticular Osteoid Osteomas are typically associated with nonspecific symptoms similar to other common joint disorders.

Pain is usually less intense when compared to osteoid osteomas of other regions, and so is its response to its response to nonsteroidal anti-inflammatory drugs is also milder.

The intraarticular nidus is difficult to identify, and there is no periosteal reaction.

The diagnosis is often delayed in such cases.

Subperiosteal

Subperiosteal osteoid osteoma is a relatively rare lesion. Conventional radiographs demonstrate a lucent lesion on the surface of the bone with an adjacent periosteal reaction.

The nidus is typically radiolucent with no evidence of central opacity.

This osteoid osteoma is larger in size because the restricting compressive force on side of periosteum is absent. The subperiosteal lesions are on average less sclerotic and have thinner trabeculae and a greater proportion of stromal tissue compared with intracortical lesions.

Presentation –  Osteoid Osteoma Symptoms and Sign

Dull aching pain at the site of the lesion is the main presenting symptom. The pain is usually worse at night and decreases by morning in the majority of patients. Awakening due to pain is reported in about one-third of patients.

The pain responds dramatically to NSAIDs. This also goes in favor of the inflammatory nature of this lesion.

Spinal lesions may present with scoliotic deformities of the spine. Radicular pain may be present.

When the lesion is around the growth plate of the bone, growth disturbances may also occur.

Joint pain and swelling may occur in juxta-articular lesions.

In lower limb lesions, limp may occur.

Diaphyseal regions of bone may present with swelling

Lesions of the small bones may lead to an expansion of the bone and may present protuberance or swelling of the region, macrodactyly [enlarged digit]

Tenderness is present in more than 50% of patients and usually occurs with subperiosteal lesions and is relatively uncommon with medullary lesions.

Local warmth and redness is also a less common finding. Joint swelling and synovitis may be found in intracapsular lesions. Soft-tissue swelling, contractures, and a soft-tissue mass can be an associated finding.

In cases of intracapsular lesions, synovium is generally edematous and thickened. Synovial changes spontaneously subside after removal of the nidus.

Lab Studies

Usually normal findings.

Imaging

X-rays

The radiographic changes are noticeable after a long period. Initial x-rays are normal in most of the cases.

Therefore, repeat radiographs should be obtained from time to time to document osseous manifestations.

Radiographs reveal a well-demarcated lytic lesion (nidus) surrounded by a distinct zone of sclerosis. A zone of central opacity that represents a more sclerosis.

A zone of central opacity that represents a more sclerotic portion of the nidus and is surrounded by a lucent halo may be present within the nidus.

In many cases, nidus may not be visible on x-ray, thus necessitating additional images like computed tomography, radioisotope scanning, and magnetic resonance imaging may be necessary.

In vertebral locations, the nidus is often not seen. The x-rays may show an increased density of the pedicle, loss of a distinct contour, or both.

Better imaging may be needed for localization of nidus.

Expansion of the bone contour can be found in the small bones.

An intraarticular osteoid osteoma may lead to periarticular osteoporosis and induce joint destruction

Lesions near the physis may induce premature fusion of the epiphysis in rare cases.

Radionuclide scanning

Radionuclide scans are indicated when radiographic findings are either normal or unable to diagnose.

It is a very useful investigation in such situations, especially in pediatric patients.

The scans show nonspecific but intense, well-defined uptake of activity on bone scans. This focus of intense uptake is correlated with the nidus.

Radionuclide scans also help the surgeon in resection of tumor and also suggests multiple bone involvement.

The investigation as 100% [picks up all cases of osteoid osteoma] and 100% specificity [ no negative bone-scan findings have been reported in patients with osteoid osteoma]

Computed tomography

CT is the primary investigator for the definitive diagnosis of osteoid osteoma

CT is helpful in precisely define localization and delineation of the nidus. It is able to determine the extent of bony involvement.

CT is indicated

  • Nidus is not visible on routine x-rays
  • Residual or recurrent tumor
  • The tumor is located in a critical area 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]

Magnetic resonance imaging

MRI has not been useful in the diagnosis of osteoid osteoma. It is reserved for equivocal cases and sensitive in detecting bone marrow, peritumoral edema, and soft-tissue abnormalities.

Localization of lesion

Localization of osteoid osteoma is important because exact localization of the lesion is the most important determinant of successful surgical treatment.

Preoperatively, radionuclide scanning and CT are the most important investigations for preoperative localization.

Intraoperative localization can be done by tetracycline labeling and frozen section examination.

Multiplanar fluoroscopy and intraoperative radioisotope scanning are radiological measures for localization during surgery.

Differential Diagnoses of Osteoid Osteoma

Underlying osteoid osteoma is ruled out in virtually all cases of unexplained back pain and painful scoliosis that occur in children and young adults.

In some patients, clinical symptoms may suggest a neurologic disorder, lumbar disc disease, or both conditions.

In small bones of hand and foot, osteoid osteoma can mimic an inflammatory process. It is not unusual for a patient with osteoid osteoma of the hands and feet to be treated initially for chronic osteomyelitis or other inflammatory conditions.

Other conditions which might appear similar in symptoms and signs

  • Chronic and acute osteomyelitis
  • Bone abscess
  • Intracortical hemangioma
  • Bone island
  • Stress fracture
  • Ewing’s sarcoma
  • Intracortical osteosarcoma.

Osteoid Osteoma Treatment

Medical Treatment

Initial treatment of osteoid osteoma remains nonoperative, with medications. Some of these patients can be managed with prolonged treatment with nonsteroidal anti-inflammatory drugs. Salicylates and naproxen are most used nonsteroidal anti-inflammatory drugs.

Sequential radiographs at 3- 6-months may suggest healing of the lesion.

Some patients have good pain relief and are continued with this. However, the effect may diminish in others and surgery may be chosen.

Osteoid osteomas are known to regress with time in some cases.

Surgical Treatment of Osteoid osteoma

In patients whose pain does not respond to drug treatment or there is a problem with nonsteroidal anti-inflammatory drugs, surgery should be considered. Patients who find difficult to restrict activity are also candidates for surgery.

Surgery, whether conventional or minimally invasive, seeks complete excision of the nidus.

Open Surgery

En bloc resection

En bloc resection is the resection of the lesion in toto to ensure complete removal of the nidus.

Disadvantages of this procedure include excessive resection of normal bone in the effort to completely excise the lesion.

The procedure is contraindicated in patients with lesions in areas difficult to access, such as the acetabulum or femoral head and neck.

En bloc surgical resection of the tumor is associated with longer healing times, prolonged hospital stay, fractures in the perioperative period, need for bone grafting and internal fixation, joint stiffness etc.

Unroofing and curettage

In this procedure, overlying bone is removed and the tumor is excised excision with curettes and burrs. It can achieve a cure rate of 75-100%.

Unroofing and curettage is especially helpful in treating lesions in a structurally vital location, such as the femoral neck where much bone loss cannot be afforded without disturbing structural support for the area.

Prophylactic internal fixation where needed may be done if the treatment weakens the remaining bone.

Similarly, spinal fusion is recommended if instability results from the treatment.

Recurrence after Open Surgery

Reported recurrence rate after open surgery is 9-28%.

Recurrence is typically observed within 1 year after excision; hence, the patient should be monitored for a minimum of 1 year.

Failure to relieve pain indicates incomplete removal of the tumor and bad prognosis

Minimally Invasive Surgery

Radionuclide-guided excision

Three hours before surgery, the radionuclide [technetium-99m-labeled hydroxymethylene diphosphonate (HMDP) and dichloromethylene diphosphonate (DMDP)] is given to the patient. Scanning after one hour localizes the hot spot.

A detector probe is then used to locate the hot spot during surgery. The method is reported to localize the nidus with a precision of 2 mm enabling the excision of lesions with minimal damage to the normal bone. The same probe can also determine completeness of removal.

False positive results during surgery or for completion assessment are a problem.

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. The reported success rate is 83-100%.

Percutaneous Laser Photocoagulation

An optical fiber or fibers are inserted directly into the target tissue, followed by treatment with laser energy for several minutes. The cure rate of 93% and 96% are reported after the second ablation.

Percutaneous Radiofrequency Ablation

An electrode is placed in the lesion which is coupled to a radiofrequency generator. This would lead to that produces local tissue destruction by converting radiofrequency into heat. This method can treat a smaller lesion in a single application. Larger lesions may require a second application.

The patients can be sent home the same day and it is the method of choice in suitable patients. The procedure is most suited for treatment if the location of the osteoid osteoma should permit a safe access and a safe heating procedure without risking to damage nerves, major blood vessels, and the skin.

[ If the tumor nidus is more than 1 cm away from these structures the procedure can usually be safely performed.]

Complete or nearly complete relief of pain often occurs within 3 days. Younger patients and lesion of 10 mm are associated with increased risk of treatment failure.

Primary cure rates are 83-94%. Cure with a second ablation procedure is approximately 100.
Patients may return to work, school and other normal activities usually within the first week after the procedure. Athletic activities are prohibited for 3 months.

It should be considered that recurrence rates of 10-20% have been described and a second procedure may sometimes be required especially in large lesions.

Percutaneous radiofrequency coagulation is currently the preferred treatment for osteoid osteoma because it does not require hospitalization, is not associated with complications, and is associated with rapid convalescence.

Here is a short video outlining the procedure

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

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.

 

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Reader Interactions

Comments

  1. 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,

  2. 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

  3. @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.

  5. 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"

  6. @Jeffrey Spalt,

    There is no secret. Things happen painstakingly slowly when the treatment aspect is a concern.

    Good to know it worked for you.

  7. 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.

  8. @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

  9. 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

  10. @Santo,

    Yes! Your treatment appears on the right line. If RFA des not work another option is removal by surgery.

  11. 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.

  12. 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

  13. I have a small bone growth in my forehead. I cannot find any surgeon to remove it.Please help

  16. @rajesh,

    Both surgery and RFA are effective. The best place of treatment would a center with experience in musculoskeletal cancer surgeries.

  17. 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

  18. @Erin lewis,

    Osteoid osteoma needs either surgery or ablation. Did you discuss it with your treating doctor.

  19. 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.

  20. @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.

  21. 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 ??

  22. 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

  23. 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?

  24. @fuad,

    Most of them spontaneously resolve. You might want to wait if you could bear the discomfort or manage with symptomatic treatment.

  26. @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.

  27. 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.

  29. 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??

  30. 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.

  31. 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….

  32. @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.

  33. 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

  34. @Adey,

    Osteoid osteomas are known to remit with time. Just keep a watch and take symptomatic medication for few years if it is possible.

  35. 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.

  36. 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.

  37. 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.

  38. 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.

  39. 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

  40. 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!

  41. 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??

  42. @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.

  43. @hiren,

    OO resolves in some cases with time. If it is not troublesome, you may opt for wait and watch.

  44. @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.

  45. 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.

  46. 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……

  47. 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.

  48. 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…

  49. 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…

  50. @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

  51. @Ashley Geiser,

    Osteoid osteoma is treatable. What has your doctor suggested?

  52. 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

  53. @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.

  54. @aditya,

    Osteoid osteoma is a bone tumor. What was declared wrong in FNAC..

  55. @sujan bhusal,

    Usually not if the nidus has been removed.

    How are you now?

  57. @Reshma,

    I am sorry I am not aware of centers in Banglore. A search with local medical community would help.

  58. 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.

  59. 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.

  60. 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

  61. 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

  62. @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.

  63. 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.

  64. 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.

  65. 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.

  68. @Happiness,

    Every procedure does carry a risk and you need to discuss it beforehand if there is any concern about complication etc.

  69. @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.

  71. 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

  72. 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.

  73. 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.

  74. 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.

  75. 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.

  76. 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

  78. 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?

  80. 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?

  82. 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.

  83. 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 .

  85. 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??

  86. 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

  87. 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?

  88. 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.

  89. 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

  90. 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.

  91. 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.

  93. 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!

  94. 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.

  95. 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

  96. 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.

  97. 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.

  98. 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.

  99. 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.

  100. karan,

    If it is there for 4 years, you should consider surgery or other procedure to remove the tumor.

  101. 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 !

  102. Technically it should be fine. But lesion needs to be monitored with regular imaging.
    Take care.

  103. 8 yrs boy with osteoid osteoma.
    His body weight is 37 kg
    We prefer medical treatment.
    May I know correct dosage of aspirin

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