[Osteoid osteoma--a diagnostic and therapeutic problem?]

The aim of the following article is to summarize our experience in the treatment of osteiod osteomas, with special emphasis on diagnostic and therapeutic pitfalls.

A consecutive series of 14 patients with osteoid osteomas was treated surgically between 1985 and 1996. All tumors but one were located in the lower limb. The main symptom was pain, being worse at night and being responsive to oral salicylates (10/14 patients). As reported in other studies, the duration of symptoms was unacceptably long (mean 24 months). The classical pathognomonic symptoms were misinterpreted in many cases, leading to frustrating conservative and even operative therapies.

Open biopsy prior to surgical excision is not indicated because of the typical clinical and roentgenographic imaging of these lesions. Surgical excision of the nidus is the treatment of choice and gives immediate pain relief. If the characteristic morphology is not evident in plain roentgenograms, conventional tomograms, radionuclide scans and computerized tomography are reliable tools. All patients were free of disease at a mean of 6.6 years after operation.

In symptomatic patients with osteoid osteomas the excision of the nidus is the established diagnostic/therapeutic modality. Minimally invasive procedures seem to be alternatives to classical surgery.