Disclosures: Joseph P. Shivers, MD: No financial relationships or conflicts of interest

Case Diagnosis: Osteoid osteoma of the left T12 inferior articulating process

Case Description or Program Description: An 18-year-old female dancer presented with left-sided, thoracolumbar axial back pain that had worsened over two years. The pain was associated with limitation of lumbar extension and had started to interfere with sleep despite activity modification, physical therapy, and non-steroidal anti-inflammatory drugs. X-rays of the thoracolumbar spine were unrevealing. Magnetic resonance imaging (MRI) of the lumbar spine was notable for edema in the posterior elements of T12, which were incompletely visualized. Computed Tomography (CT) and MRI without/with contrast of the region were consistent with an osteoid osteoma (8 millimeters x 7 millimeters) within the left inferior articulating process of T12, associated with synovitis of the left T12-L1 zygapophysial joint. A trial of aspirin did not give meaningful relief.

Setting: Academic medical center adult physical medicine and rehabilitation (PM&R) clinic

Assessment/Results: After discussion among PM&R, neurosurgery, and neuroradiology, in shared decision-making with the patient, she underwent radiofrequency ablation of the lesion under CT guidance. Eight weeks after the procedure she felt better, and her Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire reflected dramatic improvements in pain, physical function, and anxiety.

Discussion (relevance): Osteoid osteoma is a benign entity that accounts for approximately 10% of bone tumors, Ten percent of osteoid osteomas occur in the spine, predominantly in the posterior elements of the lumbar spine. Presentation is usually in childhood or adolescence. The classic CT finding is a round, radiolucent lesion that contains a radiodense nidus.

Conclusions: Persistent, worsening activity-associated back pain in an otherwise healthy adolescent merits advanced imaging. Many patients with this clinical picture are found to have a pars interarticularis fracture. The differential diagnosis also includes osteoid osteoma, for which treatment options include surgical excision and radiofrequency ablation. Lesions at or near the thoracolumbar junction may not be well seen on standard lumbar imaging protocols.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/progressive-thoracolumbar-back-pain-in-an-adolescent-female-dancer-a-case-report/