Osteoid osteoma and osteoblastoma

Osteoid osteoma is a benign bone-forming tumor, characterized by a small, radiolucent nidus typically less than 2 cm on X-ray. It presents as a progressively dull and aching pain that is particularly increased at night and may or may not be related to the activity. Characteristically, the pain resolves with the administration of nonsteroidal anti-inflammatory medications (NSAIDs). In patients with spine lesions, scoliosis, paraspinal muscle spasms, and a restricted range of motion may also be present. More commonly than osteoid osteoma patients, osteoblastoma patients have isolated spinal involvement. On X-ray, osteoblastoma appears very similar to osteoid osteoma but is larger (>2 cm). Spinal lesions may not be visible on X-ray due to location in the spine. In these cases, CT scan is the next preferred imaging modality for spinal lesions, to identify the size and location of the lesion. MRI is generally not recommended due to the "flare phenomenon. " For osteoid osteoma, first-line treatment is clinical observation and NSAID treatment. Medical management is not effective in patients with osteoblastoma. Operative management can be performed with CT-guided radiofrequency ablation (RFA) or superficial resection.