Scoliosis secondary to lumbar osteoid osteoma A case report of delayed diagnosis and literature review

Rationale: Lumbar osteoid osteoma has a low incidence, which could easily lead to scoliosis. Patient concerns: Scoliosis secondary to lumbar osteoid osteoma could be easily misdiagnosed when patients do not complain of obvious symptoms. Diagnoses: We reported a case of a 9-year-old boy with back deformity that was firstly diagnosed with scoliosis at the local hospital. After prescribed with orthosis, the patient experienced aggravating pain that could not be relieved with painkillers. After he admitted to our hospital for further medical advice, he was prescribed to complete radiological examinations. Considering his radiological examination results and his medical history, correct diagnosis of lumbar osteoid osteoma was made. Interventions: Surgical intervention of posterior lesion resection was conducted after diagnosis. Intra-operative frozen pathology indicated features of osteoid osteoma. As the lesion involved inferior articular process of L5, which could cause lumbar instability after lesion resection, internal fixation was conducted at L4-S1 segment, and posterolateral bone fusion was also conducted at L5-S1 segment. Outcomes: Three months after operation, the patient showed marked improvement of scoliosis deformity and great relief of lumbar pain. Lessons subsections: Although spine osteoid osteoma is clinically rare, it shall not be overlooked when young patients present with scoliosis first. Radiological results including computed tomography and magnetic resonance imaging shall be taken carefully as reference when making diagnosis. Surgical intervention of lesion resection could well improve scoliosis and relieve lumbar pain.