Kotheeranurak Vit, Jitpakdee Khanathip, Rujiramongkolchai Napaporn, Atikankul Taywin, Singhatanadgige Weerasak, Limthongkul Worawat, Tejapongvorachai Taweechai, Kim Jin-Sung
Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand
Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand.
Int J Spine Surg. 2022 Apr;16(2):378-383. doi: 10.14444/8210. Epub 2022 Mar 10.
Osteoid osteoma (OO) is a common benign bone tumor; however, approximately 25% of cases have spine involvement. It is often treated by image-guided radiofrequency ablation to break down the nidus. Few reports have described full endoscopic resection of the lesion, but none have described postoperative remodeling of the lumbar facet joint after surgical resection of an OO. The study aimed to describe a rare case of remodeling of the lumbar facet joint and then delineate the least invasive surgical technique of endoscopic resection of an OO.
A 26-year-old man presented with severe left buttock pain and sciatica that worsened at night and was relieved by ibuprofen. Magnetic resonance imaging indicated a left inferior facet of an L3 mass-like lesion. A thin-section computed tomography image revealed a nidus, which was compatible with an OO. Full endoscopic resection was performed to completely remove the nidus of the OO.
At the 2-year follow-up, the patient was symptom-free and computed tomography images indicated new bone formation.
The present case and literature review demonstrate that endoscopic resection is safe and effective for managing a posterior element of lumbar OO. Furthermore, this technique allows complete removal of the nidus with minimal damage to surrounding structures and leads to remodeling of the resection site.
Patients with OO involving the posterior element of the spine can present with buttock and radicular pain, mimicking lumbar disc herniation. OO can be successfully removed by the full endoscopic method and remodeling of the resected site can be anticipated.
骨样骨瘤（OO）是一种常见的良性骨肿瘤；然而，约25%的病例累及脊柱。其常通过影像引导下的射频消融来破坏瘤巢进行治疗。很少有报告描述对该病变进行全内镜切除，但尚无报告描述骨样骨瘤手术切除后腰椎小关节的术后重塑情况。本研究旨在描述一例罕见的腰椎小关节重塑病例，并阐述骨样骨瘤内镜切除的微创外科技术。
一名26岁男性出现严重的左侧臀部疼痛和坐骨神经痛，夜间加重，服用布洛芬后缓解。磁共振成像显示L3左侧下关节突有一肿块样病变。薄层计算机断层扫描图像显示一个瘤巢，与骨样骨瘤相符。进行了全内镜切除以完全去除骨样骨瘤的瘤巢。
在2年的随访中，患者无症状，计算机断层扫描图像显示有新骨形成。
本病例及文献综述表明，内镜切除治疗腰椎骨样骨瘤的后部结构是安全有效的。此外，该技术能在对周围结构损伤最小的情况下完全去除瘤巢，并导致切除部位的重塑。
累及脊柱后部结构的骨样骨瘤患者可出现臀部和神经根性疼痛，类似于腰椎间盘突出症。骨样骨瘤可通过全内镜方法成功切除，且可预期切除部位会发生重塑。
