The management of osteoid osteoma: updates and controversies

Osteoid osteoma is a benign painful bone tumor usually found in the lower extremities of children and young adults. It has been traditionally treated by surgical excision. Despite the small size of the lesion, the operative procedure for its removal can be extensive, but still sometimes remains incomplete. The purpose of this review is to highlight and discuss current developments in the management of osteoid osteoma.

During the past decade, efforts were deployed to minimize bone removal, lessen the risk of pathologic fracture and the need for bone grafting, and thereby shorten the period of convalescence. Improved methods for the precise localization of an osteoid osteoma with use of radioisotope scanning or computed tomography scan have made it possible to treat this lesion with more limited and effective operations, mainly in deep and non-easily accessible osteoid osteomas.

Although they bear the criticism of lacking histological proof for diagnosis of osteoid osteoma, minimally invasive techniques, such as computed tomography-guided percutaneous radiofrequency thermal ablation and laser photocoagulation have become the methods of choice for the treatment of all localizations except those in contact with neural structures (awaiting further research and experience), provided that the diagnosis is based on a typical clinical, scintigraphic and computed tomography presentation.