FEMORAL HEAD OSTEOID OSTEOMA AND LUMBAR DISC HERNIATION: CASE REPORT

We describe a clinical case of coexisting osteoid osteoma of the femoral head and L4-L5 disc herniation in a 17-year-old female patient. After a minor incident when she lost her footing while walking, she started to experience acute right groin pain, followed later by hip joint pain. Paraspinal muscle tenderness and pain at the L4-5 level were found on palpation. Hip motion was limited and gait was antalgic. Computed tomography (CT) of the lumbar spine revealed a disc herniation. The patient underwent two surgical interventions but no pain relief was achieved. Attention was then directed to the hip joint. CT and magnetic resonance imaging (MRI) revealed a lesion, highly suggestive of osteoid osteoma of the femoral head. Surgical removal of the tumor was performed. The patient was no longer feeling pain. Hip motion was entirely restored, and gait returned to normal. Follow-up imaging showed no recurrence one year after the intervention. In summary, the problem was solved in 22 months, after prolonged treatment with nonsteroidal anti-inflamatory drugs and analgesics, 3 CT and 5 MRI scans, 5 hospitalizations and 3 surgical interventions. In this paper we discuss some diagnostic and treatment challenges in osteoid osteoma, emphasizing the need for its early detection and recognition.