Study Design: A case report is being presented to highlight the fact that in cases of Osteoid osteoma of spine where RF ablation is not possible conventional surgery applied with concept of minimal invasive technique and preserving the structures give equally gratifying resultsObjectives: To prove that in cases of tumor being close to neural tissue, Radio frequency ablation is ruled out, but intra lesional excision without fusion of spinal segment is possible Summary of Background Data: Radiofrequency Ablation is now a standard treatment in case of osteoid osteoma in case where en- block resection is not possible, but even it has limitatations and conventional surgery applied with concept of minimal invasive technique and preserving the structures give equally gratifying resultsMethods: A review of literature and a case report is presented of a 16year-old girl with Osteoid osteoma of pedicle of L4 vertebra of spine, which was excised without creating instability at involved spinal segment, thus avoiding fusion and maintaining mobility at the segment. Results: Excision of the nidus was confirmed by relief of symptoms, post excision computed tomography scans, and histologic evaluation on clinical and radiographic follow-up observation Conclusions: The excision for osteoid osteoma of the pedicle of L4 with minimal bone resection and preservation of the posterior spinal structures helps in preserving the motion segment Introduction Osteoid Osteoma is a benign bone lesion with a nidus of less than 2 cm surrounded by a zone of reactive bone. Tumor may be found in any bone in the body. 10% of cases involve the spine. Lumbar spine is the commonest site (59%) with the neural arch being the usual location (75%). Osteoid osteoma has a distinct clinical picture of dull pain that is worse at night and disappears within 20 to 30 minutes of treatment with non-steroidal anti-inflammatory medication (normally Aspirin). The classic radiological presentation of an osteoid osteoma is a radiolucent nidus surrounded by a dramatic reactive sclerosis in the cortex of the bone. Radiography is the initial examination of choice and may not be the only examination required. CT is used for precise localization of the nidus and may be used for guiding percutaneous ablation. MRI is a useful imaging technique, but CT appears superior for precise localization. Radionuclide scanning for technetium-99m diphosphonate uptake shows fairly intense activity at the tumor site. The tumors may regress spontaneously. The mechanism of this involution is not known, but tumor infarction is a possibility. When the spinal column is involved, muscle spasms may cause abnormal alignment. A painful scoliosis may be concave toward the lesion. Kyphoscoliosis, torticollis, and exaggerated lordosis may also be seen. Osteoid osteoma has been called the most common cause of painful scoliosis. Definite neurological abnormalities are seen in 6.5% of patients with spinal osteoid osteomas. Although the natural course of osteoid osteoma is one of potential spontaneous remission over a period of two to eight years, spinal tumors usually are treated with en bloc excision because of the risk that the compensatory scoliosis will become structural. The purpose of the present report is to describe the case of a patient who had a lumbar osteoid osteoma with a fairly typical presentation that was treated with a novel surgical approach Materials and Methods Case ReportA sixteen year-old girl presented with a six-month history of low-back pain that worsened with activity. She reported no history of trauma, weight loss, fevers, chills, sweats, or night pain. She had no neurological symptoms. Prior to presentation, she had been seen by two different physicians and one orthopedic surgeon for evaluation of her complaints. The medical and surgical histories were unremarkable. The patient had a negative family history for scoliosis and other vertebral deformities. The use of nonsteroidal anti-inflammatory
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