L5 Osteoid Osteoma Treated with Partial Laminectomy and Cement Augmentation

Area of Science:

• Orthopedic Surgery
• Oncology
• Radiology

Background:

• Osteoid osteoma is a benign bone tumor often affecting young males, commonly presenting with nocturnal pain.
• Spinal osteoid osteomas occur in 20% of cases, potentially causing deformity, stiffness, and debilitating pain.
• Previous treatments like radiosurgery and radiofrequency ablation were ineffective for this patient's L5 laminar lesion.

Observation:

• A 22-year-old male presented with chronic low back pain and severe radicular symptoms due to a metabolically active L5 laminar osteoid osteoma.
• The lesion measured 11 x 10 mm, causing neuroforaminal narrowing and refractory pain despite conservative management.
• The osteoid osteoma was resistant to physical therapy, NSAIDs, aspirin, and radiation therapy.

Findings:

• A novel surgical approach of en-bloc resection via partial laminectomy was performed on the L5 lamina.
• The resected lesion was confirmed as osteoid osteoma with associated marrow edema.
• Vertebral column strength was preserved using bone cement augmentation following tumor resection.

Implications:

• Partial laminectomy with cement augmentation is a viable technique for spinal osteoid osteomas, preserving vertebral integrity.
• This surgical approach can prevent pars interarticularis fracture and the need for lumbar fusion in young patients.
• The procedure resulted in significant improvement of radicular symptoms and low back pain, with the patient remaining neurologically intact.