Excision of an osteoid osteoma from the body of the axis through an anterior approach.

Osteoid osteoma is seen less commonly in the vertebral body than in the posterior elements of the spine. To the authors' knowledge, this is only the second reported case of an osteoid osteoma affecting the body of the axis. The patient described in this report presented with the classic symptomatology of pain and torticollis. Radiological imaging confirmed the diagnosis. A superior extension of the anterior Smith-Robinson approach, through the "window of access" described by Fasel, was used to excise this lesion. Following surgical excision, there was complete resolution of the presenting symptomatology and functionally the range of motion of the cervical spine returned to normal. We avoided instrumentation and C1-C2 fusion so that rotation of the cervical spine could be maintained. There were no signs of recurrence of the tumour within the 4-year follow-up period. It presented in a classic way but, despite this, it took 2 years from the onset of these symptoms to reach a definitive diagnosis. This osteoid osteoma was successfully excised through a superior extension of the anterior Smith-Robinson approach.