OSTEOID OSTEOMA DIAGNOSIS AND MANAGEMENT WITH LOW MORBIDITY

Wide excision, a recommended treatment for osteoid osteoma, creates ne edless resection of surrounding bone and causes difficult intraoperati ve nidus identification. Less bone resection is required by successive ly burring through the reactive bone to identify the nidus, which is t hen removed with curettes and burrs. This burr-down technique requires precise preoperative anatomic localization by thin section (1-1.5 mm) computed tomography (CT) scans. In a consecutive series of 19 osteoid osteomas, 18 were accurately diagnosed before operation, using a comb ination of clinical findings, plain roentgenograms, and CT scans. The burr-down technique was successfully used in 15 cases, and four were t reated with wide excision. There have been no local recurrences. The f ollow-up period for all 19 patients was at least six months. No bone g rafts were required in the burr-down group in nonspinal locations; the re have been no fractures despite early return to unrestricted activit y. The burr-down technique was associated with less postoperative immo bilization, a shorter duration of protected weight bearing, and an ear lier return to activity. The burr-down technique is recommended for ac cessible osteoid osteoma lesions.