Thoracic Osteoid Osteoma: Surgical Approaches and Management Strategies

Introduction: Osteoid Osteoma (OO) is a rare, benign, primary bone-producing neoplasm. While it predominantly affects the long bones, it may also impact the lumbar region of the spine. Thoracic OO is less common, observed in 12-17% of spinal OO. Clinical manifestations are often nonspecific, but may present with localized spinal tenderness, back pain/stiffness, muscle spasms, painful scoliosis, radiculopathy and spinal cord/nerve root compression. Surgical management includes intralesional excision, curettage, marginal or en-bloc resection with/without radio-frequency ablation, percutaneous radio-frequency ablation, or gamma probe-guided high speed intralesional drill excision.

Methods: A systematic review of the literature was performed in accordance with PRISMA guidelines to identify OO with thoracic involvement cases (1976-2024). PubMed, SCOPUS, and EMBASE were searched using search terms “OO” AND “thoracic”. Variables recorded include demographic characteristics, age of symptom onset and intervention, spinal level/site, pain duration, presence/absence of scoliosis, imaging, intervention type, complications, recovery, and recurrence.
We present the case of a 69-year-old male with T10 OO, exhibiting spastic paraparesis in lower extremities and sphincter dysfunction, who underwent laminectomy and en-block excision of OO.

Results: The search resulted in 32 studies, with 24 case reports and 8 studies. 54% were female, and 46% male, with a mean age of onset of 26.4 years and mean age of intervention of 27.4 years (6-64 yo). T9 and T10 were the most affected thoracic levels, whereas T5 and T7 involvement was less frequently observed. The lamina was the most common site encountered, and CT was the primary diagnostic tool. The symptom duration ranged from 1 month -8 years. Pain was managed with NSAID. 46% of patients exhibited scoliosis. Out of patients who underwent percutaneous core excisional biopsy with fluoroscopic guidance, only one experienced local recurrence after 6 months, which resolved with reintervention. Multicenter studies illustrated male predominance, a high recurrence rate associated with radiofrequency ablation and en-block excision approaches, and an increase age at intervention.

Conclusion : Timely surgical intervention, precise intraoperative localization, and tailored surgical intervention are essential in achieving favorable outcomes in thoracic OO.