Osteoid osteoma of the atlantoaxial spine: primary observation of the clinical treatment

English Keywords:Osteoid osteoma  Atlantoaxial spine  Treatment  Surgery  Nonsteroid anti-inflammatory drugs

English Abstract:

  【Abstract】 Objectives: To discuss the treatment and the clinical effect of the osteoid osteoma of the atlantoaxial spine. Methods: A retrospective review of 5 patients with the atlantoaxial osteoid osteoma admitted in our hospital between 2000 and 2011. There were 3 males and 2 females, with a mean age of 12.2 years(from 6 to 22 years old). All patients complained neck pain with constant nocturnal severe pain, and VAS ranged from 7 to 8, averaging 7.8. The NSAIDs tests were positive. 4 patients presented with marked torticollis. No one had neurological defect. Bone scan was positive in all patients. Computed tomography confirmed the location of lesions: C1 lateral mass was involved in 2 cases, 3 were located in the dense axis. The maximal diameter of the nidus was from 10 to 15mm, with an average of 11.8mm. 4 patients received NSAIDs drug therapy for at least six months, 3 of them achieved intralesionally curettage because of the poor response to the conservative treatment, and only one patient maintained drug therapy. The patient with atlantoaxial dislocation secondary to C1 lateral mass lesion accepted a posterior reduction surgery, and tumor curettage was not performed. All the patients received the post-operative medicine cure with NSAIDs drug. Results: The surgery took 110min in average, and the average blood loss was 40ml. Symptoms were relieved immediately after surgery, and torticollis was corrected. No surgery related complications occurred. There was no symptom recurrence or tumor progress during the follow-up(mean time 21.6 months). One patient stopped drug therapy 1 year after surgery without symptom recurrence. The nidus sclerosis was found in 2 patients who accepted conservative therapy. Conclusions: The osteoid osteoma of the atlantoaxial spine is less common. Intralesionally curettage operation should be selected for cases with poor response to the conservative treatment or with secondary damage. Surgical removal is selected for the appropriate cases. It is better to keep using NSAIDs therapy after operation.