A 20-year-old male presents with a painful scoliosis and nocturnal back pain relieved by aspirin. CT scan shows a nidus of <1 cm with surrounding sclerosis in the posterior element of L3. The most likely diagnosis and preferred treatment is:
- A Osteoblastoma — en bloc surgical excision
- B Osteoid osteoma — CT-guided radiofrequency ablation (RFA) ✓
- C Aneurysmal bone cyst — curettage and bone grafting
- D Bone island (enostosis) — observation
Explanation
Osteoid osteoma is a benign bone-forming tumor characterized by a nidus <1.5 cm on imaging with surrounding sclerosis, nocturnal pain classically relieved by aspirin/NSAIDs (prostaglandin-mediated), and when in the spine, it produces painful reactive scoliosis (the nidus is on the concave side). CT-guided radiofrequency ablation (RFA) is the modern gold-standard treatment — minimally invasive, 90%+ success rate, short hospital stay. Surgical excision is the alternative for inaccessible lesions. Osteoblastoma is larger (>1.5–2 cm), less painful, and not aspirin-sensitive; it requires surgical excision.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.