Wide surgical excision for osteoid osteoma. Should it be the first-choice treatment?

Osteoid osteomas (OO) are benign skeletal tumors with a predilection for the long bones of young patients. Many different methods are used for their treatment, conservative or operative, less or more radical, with variable technology applications to destroy the "nidus." We present 38 patients with OO who were treated in our hospital between 1995-2001. Their medical records and radiographs were retrospectively reviewed, and the patients were contacted and interviewed by telephone. In 32 patients, OO were located in the lower limb, in two the upper limb, and in four the spine. Thirty-seven patients were treated operatively using open wide excision of the nidus. In 22 of those patients, additional bone grafting was used. In three patients, prophylactic internal fixation was applied to the bone. Two patients developed deep-vein thrombosis; another two had increased pain in the anterior superior iliac spine from the bone graft harvesting area. We had one recurrence, which was treated with a second operation. We conclude that although the traditional method of treatment is wide surgical excision, this technique has increased morbidity and higher risk for complications compared to more minimally invasive procedures. We suggest that it should be the first choice of treatment for either spinal or recurrent OO.