Say What? Osteoid Osteoma of the Spine

Osteoid osteoma is a fancy term for small, benign, bonelike tumors that can grow on the spine (among other areas). Although they’re not cancerous, they can cause pain and abnormal spine curves. Here’s how to get rid of them.

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Osteoid osteoma of the spine is a fancy term for a relatively simple condition. It’s a small, benign spinal tumor, and although it may cause pain--especially at night--it often responds well to over-the-counter pain relievers and may go away on its own. If your symptoms are unmanageable, however, multiple treatments are available.

Osteoid osteoma of the spineOsteoid osteoma of the spine are benign spinal tumor that can cause pain and abnormal spine curves.

What Is an Osteoid Osteoma of the Spine?

Let’s break it down. Osteoid is a type of tissue that eventually becomes bone. Osteoma is a type of tumor that’s unique to bones.

According to Chris S. Helmstedter, MD, director of orthopedic oncology at Southern California Permanente Medical Group, they’re actually quite small —typically less than an inch across.

Osteoid osteomas represent 10 percent of all benign bone tumors and just one percent of all spinal tumors.

In addition to appearing on the spine, osteoid osteomas can affect the bones of the arms, hands, fingers, ankles, or feet. According to CJ Kleck, MD, orthopedic surgeon and chief of spine surgery with UCHealth Spine Center – Anschutz Medical Campus in Denver, they’re found on the spine 10 to 15 percent of the time.

Osteoid osteomas of the spine are more likely to affect the posterior aspect, or the back of the vertebrae than the anterior, or front aspect. Any portion of the spine may be affected, however they’re most common in the lumbar spine (low back). While 60 percent of osteoid osteomas affect the lumbar spine, 27 percent affect the cervical spine, and 12 percent affect the thoracic spine.

How Dangerous Is an Osteoid Osteoma of the Spine?

While you never want to hear the words “it’s a tumor,” osteoid osteoma is not cancerous. As a benign growth, it will not spread through various organ systems as a malignant cancer might. However, it can be unpleasant and may need to be removed.

In addition to pain, there are some risks associated with osteoid osteomas. They include:

  • Scoliosis

Spinal osteoid osteoma may provoke paraspinal muscle spasms—spasms of the erector spinae, which are muscles that support your spine—that can lead to scoliosis. While the spine normally curves in and out at different areas, scoliosis creates an “S” or “C” shaped curve to the left, right or both that can impair function and mobility. Spinal osteoid osteoma is much more likely to provoke left or right curves of the spine when it affects the lumbar region.

  • Misdiagnosis
    Because osteoid osteoma can cause scoliosis, some doctors may concentrate on trying to treat the abnormal curve instead of the osteoma causing it.
  • Nerve root compression
    According to Dr. Kleck, most patients are not at risk for nerve root compression, but it’s still a risk If the growth presses up against the spinal cord, it can interfere with nerve function. This can lead to radiculopathy—radiating pain—and sciatica.

Spinal Osteoid Osteoma Causes

“The causes of osteoid osteoma are not yet fully understood,” says Dr. Helmstedter

We do know it affects some populations more frequently than others. According to Dr. Kleck, men are three times more likely to be diagnosed than women. Younger people are also more susceptible. Dr. Kleck says while you can develop it at any age, 80 percent of osteoid osteomas are diagnosed in patients under 30.

At the core of an osteoma is a growth called a nidus. According to Dr. Helmstedter, the nidus consists of growing tumor cells, blood vessels, and cells that eventually form bone. Enclosing it is a bony shell.

Signs and Symptoms of Osteoid Osteoma of the Spine

Osteoid osteomas typically cause a dull ache at the tumor site along with paraspinal muscle spasms. It’s usually worse at night and is typically relieved by non-steroidal anti-inflammatory (NSAID) medication such as ibuprofen or aspirin.

According to Dr. Helmstedter, the pain, which can also be sharp, may also occur in the daytime, growing more severe with activity and sometimes progressing over time.

The lateral spinal curves—curves to the left or right—that characterize scoliosis can also be a sign of an underlying osteoid osteoma. In some cases, however, osteoid osteomas of the spine have no symptoms.

Diagnosing Osteoid Osteoma of the Spine

Your doctor might notice the soft tissue around the tumor is painful or swollen during a physical examination, says Dr. Helmstedter. While they might feel a lump, this is rare, he says.

Your medical provider will also order imaging such as an X-ray or a CT scan. “An x-ray shows bone thickening, but the CT scan will show the nidus very clearly as a darker center surrounded by thick white cortical bone,” explains Dr. Helmstedter. “Occasionally both CT and MRI are used to diagnose osteoid osteomas.”

Spinal osteoid osteoma X-rayAn X-ray can provide important clues in diagnosing osteoid osteomas of the spine, but a CT scan can show the nidus very clearly.

In some cases, you may need a biopsy, which is when your provider takes a tissue sample and sends it to the lab to be examined under a microscope. However, “a biopsy is rarely needed when the presentation is classic,” says Dr. Helmstedter

Spinal Osteoid Osteoma Treatment

Nonsurgical

NSAIDs can be quite effective, says Dr. Kleck, alleviating symptoms in as many as half of all patients. “If it is controlled with these medications, this may be the only treatment necessary,” he says.

Dr. Helmstedter says some patients do well with trying a different painkiller if their preferred medication stops working. You should however discuss pain management with your doctor, as chronic NSAID use is associated with issues such as ulcers and kidney damage, and the concerns around opioids are many and well-documented.

With this approach, the pain generally persists for about three years and the lesion often resolves within five to seven years, says Dr. Kleck.

Surgical

If your pain is not controlled or your osteoid osteomas causes scoliosis, you may need surgery. According to Dr. Helmstedter, most spinal osteoid osteomas are treated with open curettage. “Curettage requires a small incision,” he explains. “The nidus is scraped out and the edges of the cavity are further scraped with a motorized burr. Most times a small amount of bone graft material is used to fill the defect.”

Long considered the standard of care, surgical resection requires a hospital stay and recovery time and can be painful. In some cases your physician may create a smaller incision and work with CT guidance.

Radiofrequency (RF) ablation

For osteoid osteomas affecting bones other than the spine, radiofrequency ablation, a minimally invasive outpatient procedure with a short recovery time, “has become the treatment of choice,” says Dr. Helmstedter.

During this procedure, radiofrequency waves—basically heat— “cook” the nidus for up to six minutes and destroy it. Surgeons use CT imaging to precisely target the lesion. After the procedure, which takes one to two hours, you wait in a recovery room for up to four hours.

Radiofrequency ablation is less commonly used to treat spinal osteoid osteomas because of the risk of thermal nerve damage. According to Dr. Helmstedter the needle’s tip can reach up to 90 degrees Celsius (194 degrees Fahrenheit), more than enough to damage nerves. The best candidates for radiofrequency ablation are young patients with no history of neurological issues.

Osteoid osteoma may sound scary but your best defense is a knowledgeable medical provider. If you have back pain, don’t wait to get treatment. Find a spine specialist who can help.

Updated on: 08/24/20
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