Osteoid Osteoma of the Spine

What it is

An osteoid osteoma is a small, benign (non-cancerous) bone tumor that does not spread. It is most common in children, teenagers, and young adults. When it occurs in the spine, it sits in a vertebra and is tiny — usually well under an inch — but it can cause symptoms out of proportion to its size.

What it feels like

The classic story is back pain that is worse at night and is strikingly relieved by anti-inflammatory medicine like ibuprofen or aspirin. In the spine, the irritation can also cause the muscles to spasm and pull the spine into a painful, stiff curve. Because it is most common in young people, persistent night back pain in a teenager is worth taking seriously.

How we diagnose it

A CT scan shows the small tumor and its characteristic center (the nidus) especially well, and an MRI shows the surrounding reaction. The typical appearance, combined with the classic night-pain story, usually makes the diagnosis clear.

How we treat it

Some osteoid osteomas quiet down over time and can be managed with anti-inflammatory medication while they do. When the pain persists, a minimally invasive procedure that destroys the tiny tumor with heat (radiofrequency ablation) is highly effective and avoids open surgery in most cases. Open removal is reserved for tumors in locations where ablation is not ideal. The outlook after treatment is excellent.

The science — for the curious

The dramatic response to anti-inflammatory medicine is a genuine diagnostic clue: these tumors make substances that drive pain and inflammation, which is why drugs that block inflammation work so well and why the pain is classically worse at night. It also explains why a small lesion can cause a noticeable, painful curve in the spine — the body is reacting to the tumor, and removing or ablating it resolves both the pain and the reaction.

Learn more

OrthoInfo — Osteoid Osteoma: orthoinfo.aaos.org

Johns Hopkins Medicine — Spinal Tumors: hopkinsmedicine.org

This handout is general education about a common condition and does not replace the personalized advice we discuss in clinic. If anything here does not match what we talked about, what we talked about wins — please ask me.