The Open Neurology Journal




ISSN: 1874-205X ― Volume 14, 2020
CASE REPORT

Minimally Invasive Percutaneous Treatment for Osteoid Osteoma of The Spine. A Case Report



Giuseppe Mariniello1, *, Serena Pagano1, Giuseppe Teodonno1, Camilla Russo2, Giuseppe Pontillo2, Martina Di Stasi2, Michele Klain2, Gianfranco Puoti3, Andrea Elefante2
1 Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University “Federico II”, Naples, Italy
2 Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
3 Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Caserta, Italy

Abstract

Osteoid osteomas are benign but painful bone-forming tumors usually involving long bones, with localization at the spine in 10-20% of the cases. The most common symptom is back pain responding to nonsteroidal anti-inflammatory drugs, but in some cases, also radicular pain can be present. For years, surgical excision has been considered the best choice of treatment for cases with unresponsive pain and has been practiced with a high percentage of success but also a high rate of fusion with instrumentation. In the last years, percutaneous radiofrequency ablation has been proposed as a new mini-invasive technique for the treatment of osteoid osteomas.

Keywords: Osteoid osteoma, Spine, Radiofrequency ablation, Mini-invasive technique, Back pain, Percutaneous treatment.


Article Information


Identifiers and Pagination:

Year: 2020
Volume: 14
First Page: 41
Last Page: 45
Publisher Id: TONEUJ-14-41
DOI: 10.2174/1874205X02014010041

Article History:

Received Date: 24/02/2020
Revision Received Date: 05/06/2020
Acceptance Date: 15/06/2020
Electronic publication date: 27/07/2020
Collection year: 2020

© 2020 Mariniello et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University “Federico II”, Naples, Italy; Tel:+39 81 7462584, E-mail: giumarin@unina.it





1. INTRODUCTION

First described by Jaffe in 1953, osteoid osteomas (OO) are benign but painful bone-forming tumors that predominantly occur in the second and third decades of life, with a male preponderance [1Jaffe HL. Osteoid-osteoma. Proc R Soc Med 1953; 46(12): 1007-12.
[PMID: 13120827]
-4Jackson RP, Reckling FW, Mants FA. Osteoid osteoma and osteoblastoma. Similar histologic lesions with different natural histories. Clin Orthop Relat Res 1977; (128): 303-13.
[PMID: 598169]
]. Typically small in size (<15mm), OOs are characterized by a nidus of mineralized immature bone, usually surrounded by osteosclerotic reactive bone and associated with a vascularized stroma. OOs generally affect the long bones; when localized in the spine (10-20% of cases), they usually involve the posterior elements of the vertebrae, such as the lamina, the pedicles, the transverse and spinous processes and the facet joints [2Janin Y, Epstein JA, Carras R, Khan A. Osteoid osteomas and osteoblastomas of the spine. Neurosurgery 1981; 8(1): 31-8.
[http://dx.doi.org/10.1227/00006123-198101000-00007] [PMID: 7207770]
, 4Jackson RP, Reckling FW, Mants FA. Osteoid osteoma and osteoblastoma. Similar histologic lesions with different natural histories. Clin Orthop Relat Res 1977; (128): 303-13.
[PMID: 598169]
, 5Gasbarrini A, Cappuccio M, Bandiera S, Amendola L, van Urk P, Boriani S. Osteoid osteoma of the mobile spine: surgical outcomes in 81 patients. Spine 2011; 36(24): 2089-93.
[http://dx.doi.org/10.1097/BRS.0b013e3181ffeb5e] [PMID: 21304430]
].

The most common presenting symptom is back pain, which typically worsens at night and responds to treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). Indeed, high expression of cyclooxygenase-2 and high level of prostaglandins are found at the nidus and seem to play a key role in inflammation and pain genesis [6Laurence N, Epelman M, Markowitz RI, Jaimes C, Jaramillo D, Chauvin NA. Osteoid osteomas: a pain in the night diagnosis. Pediatr Radiol 2012; 42(12): 1490-501.
[http://dx.doi.org/10.1007/s00247-012-2495-y] [PMID: 23089877]
, 7Ono T, Sakamoto A, Jono O, Shimizu A. Osteoid Osteoma Can Occur at the Pars Interarticularis of the Lumbar Spine, Leading to Misdiagnosis of Lumbar Spondylolysis. Am J Case Rep 2018; 19: 207-13.
[http://dx.doi.org/10.12659/AJCR.907438] [PMID: 29479057]
]. In some rare cases, OOs can be presented with radicular pain, in particular, when localized near the intervertebral foramen. In these cases, the correct treatment strategy is controversial, and the literature lacks data [8Zenmyo M, Yamamoto T, Ishidou Y, Komiya S, Ijiri K. Osteoid osteoma near the intervertebral foramen may induce radiculopathy through tumorous inflammation. Diagn Pathol 2011; 6: 10.
[http://dx.doi.org/10.1186/1746-1596-6-10] [PMID: 21247497]
]. Surgical excision used to be considered for decades as the standard treatment in case of unremitting pain, despite conservative treatment, with a high percentage of successes but a high rate of fusion with instrumentation. Spinal fusion has some drawbacks, such as reduction of range of motion and long-term risk of development of adjacent segment disease. With the improvement of the minimally invasive imaging-guided technique over the last years, percutaneous radiofrequency ablation (RFA) has been proposed as a new interventional technique for symptomatic patients with OO [6Laurence N, Epelman M, Markowitz RI, Jaimes C, Jaramillo D, Chauvin NA. Osteoid osteomas: a pain in the night diagnosis. Pediatr Radiol 2012; 42(12): 1490-501.
[http://dx.doi.org/10.1007/s00247-012-2495-y] [PMID: 23089877]
, 9Tomasian A, Wallace AN, Jennings JW. Benign Spine Lesions: Advances in Techniques for Minimally Invasive Percutaneous Treatment. AJNR Am J Neuroradiol 2017; 38(5): 852-61.
[http://dx.doi.org/10.3174/ajnr.A5084] [PMID: 28183835]
, 10Atesok KI, Alman BA, Schemitsch EH, Peyser A, Mankin H. Osteoid osteoma and osteoblastoma. J Am Acad Orthop Surg 2011; 19(11): 678-89.
[http://dx.doi.org/10.5435/00124635-201111000-00004] [PMID: 22052644]
].

We present a case of a long-time undiagnosed spinal OO causing lumbosciatalgia.

2. CLINICAL CASE

A 30-year-old man was admitted in July 2019 to our clinic. He reported a six year long-lasting history of low back pain, increasing at night and responsive to nonsteroidal anti-inflammatory drugs. Medical and physical treatments have not led to resolution of symptoms, despite the patient increased the dosage and the frequency of the drug administration over the years. On admission, he referred progressive worsening of symptoms, weakness and recent onset of sciatic pain to his left leg. There were no abnormalities in the laboratory studies; no correlation to trauma, sport activity, nor spinal or endocrine disorders was found. At the neurological examination, positive Lasègue sign and mild weakening of the left leg were evident and the physical examination revealed limitation in his low-back range of motion, which was exacerbated by pain. Magnetic resonance imaging (MRI) and thin-slice computed tomography (CT) scan showed an 8 mm large nidus in the left L5 superior articular process, surrounded by intense reactive sclerosis (Figs. 1-2). No alteration of spinal balance or sign of degenerative vertebral disc disease was found. Technetium bone scan localized the lesion, revealing increased uptake of radionuclide in the left posterior side of the L5 vertebra (Fig. 3). Thus, a clinico-radiological diagnosis of osteoid osteoma was made. Due to the tumor localization, we opted for a minimally invasive percutaneous imaging-guided radio-frequency ablation (RFA) to preserve spinal stability and to avoid posterior lumbar fusion. Local anesthesia was administered to control pain during the procedure. The RFA was conducted until reaching a temperature of 90°, which is considered the standard to achieve a complete ablatio. The patient was observed for 2 hours, then discharged on the same day, with a 10-day clinical check-up. The day after the procedure, a transient exacerbation of sciatic pain in the left leg occurred, responding to anti-inflammatory drugs. At 6-month follow-up, the patient did not report significant discomfort and was asymptomatic.

3. DISCUSSION

OOs are relatively rare bone tumors (almost 10% of all benign bone tumors), usually involving the long bones; vertebral localization is not so common (up to 20% of cases) with a prevalence in the posterior lumbar column [2Janin Y, Epstein JA, Carras R, Khan A. Osteoid osteomas and osteoblastomas of the spine. Neurosurgery 1981; 8(1): 31-8.
[http://dx.doi.org/10.1227/00006123-198101000-00007] [PMID: 7207770]
, 11Maiuri F, Signorelli C, Lavano A, Gambardella A, Simari R, D’Andrea F. Osteoid osteomas of the spine. Surg Neurol 1986; 25(4): 375-80.
[http://dx.doi.org/10.1016/0090-3019(86)90214-4] [PMID: 3952633]
].

Due to its small size, nidus is not easily detected by plain radiographs. Magnetic resonance imaging is helpful for the differential diagnosis [12Elefante A, Caranci F, Del Basso De Caro ML, et al. Paravertebral high cervical chordoma. A case report. Neuroradiol J 2013; 26(2): 227-32.
[http://dx.doi.org/10.1177/197140091302600214] [PMID: 23859247]
-16Saracino D, D’Armiento FP, Conforti R, et al. Dramatic neurological debut in a case of Köhlmeier-Degos disease. Neurol Sci 2019; 40(10): 2201-3.
[http://dx.doi.org/10.1007/s10072-019-03952-x] [PMID: 31183675]
]. The T2-weighted magnetic resonance images can identify the nidus and the perinidal bone marrow edema, which could be the only finding for an osteoid osteoma. The main contribution of MRI is to discover the possible spinal cord or nerve roots involvement and soft tissue inflammation [12Elefante A, Caranci F, Del Basso De Caro ML, et al. Paravertebral high cervical chordoma. A case report. Neuroradiol J 2013; 26(2): 227-32.
[http://dx.doi.org/10.1177/197140091302600214] [PMID: 23859247]
, 14Mariniello G, Briganti F, De Caro ML, Maiuri F. Cervical extradural “en-plaque” meningioma. J Neurol Surg A Cent Eur Neurosurg 2012; 73(5): 330-3.
[http://dx.doi.org/10.1055/s-0032-1304222] [PMID: 22777927]
, 17Ozaki T, Liljenqvist U, Hillmann A, et al. Osteoid osteoma and osteoblastoma of the spine: experiences with 22 patients. Clin Orthop Relat Res 2002; (397): 394-402.
[http://dx.doi.org/10.1097/00003086-200204000-00046] [PMID: 11953633]
-19Harish S, Saifuddin A. Imaging features of spinal osteoid osteoma with emphasis on MRI findings. Eur Radiol 2005; 15(12): 2396-403.
[http://dx.doi.org/10.1007/s00330-005-2816-8] [PMID: 15973540]
]. Computed tomography is helpful to clarify the nature of the lesion, it well defines the anatomical features of the nidus and the extent of perinidal sclerosis. Thin-layer CT is crucial to pinpoint the nidus for preoperative planning.

OOs are well individuated by Technetium-99m bone scintigraphy due to their hypervascular composition with evidence of intense radionuclide uptake [20Schmitz A, Diedrich O, Schmitt O. [Sacral osteoid osteoma--a rare cause of back pain in childhood and adolescence]. Klin Padiatr 2000; 212(3): 110-2.
[http://dx.doi.org/10.1055/s-2000-9662] [PMID: 10916781]
, 21Boretz RS, Lonner BS. Atypical presentation of an osteoid osteoma in a child. Am J Orthop 2002; 31(6): 347-8.
[PMID: 12083588]
].

Due to its benign nature, with no potential for malignant degeneration, OOs have a good prognosis. Spontaneous regression has been reported in the literature, occurring at 33 months [10Atesok KI, Alman BA, Schemitsch EH, Peyser A, Mankin H. Osteoid osteoma and osteoblastoma. J Am Acad Orthop Surg 2011; 19(11): 678-89.
[http://dx.doi.org/10.5435/00124635-201111000-00004] [PMID: 22052644]
], therefore, some authors consider conservative management with NSAIDs.

Long-time administration of NSAIDs should be avoided for their potential negative effects. The goal of treatment remains the tumor removal.

Owing to their classical posterior localization, the management of spinal OOs is a challenge.

Surgical “en bloc” resection of the nidus and drilling of the surrounding bone sclerosis has been considered the best choice for years, with a success rate of 88 to 100%. Although it provides the benefit of histopathological diagnosis, surgery also increases the risk of transitory or permanent morbidity and may lead to some complications.

In our case, the OO involved the superior articular process and the left lamina of L5. The excision of the tumor would have required the removal of the facet joint and partial laminectomy could have resulted in spinal instability with the necessity of a posterior lumbar fusion and with important consequences on spinal flexibility and range of motion. This is in accordance with literature that reports a fusion rate of 20-50% after surgical procedures [3Kan P, Schmidt MH. Osteoid osteoma and osteoblastoma of the spine. Neurosurg Clin N Am 2008; 19(1): 65-70.
[http://dx.doi.org/10.1016/j.nec.2007.09.003] [PMID: 18156049]
, 17Ozaki T, Liljenqvist U, Hillmann A, et al. Osteoid osteoma and osteoblastoma of the spine: experiences with 22 patients. Clin Orthop Relat Res 2002; (397): 394-402.
[http://dx.doi.org/10.1097/00003086-200204000-00046] [PMID: 11953633]
, 22Nemoto O, Moser RP Jr, Van Dam BE, Aoki J, Gilkey FW. Osteoblastoma of the spine. A review of 75 cases. Spine 1990; 15(12): 1272-80.
[http://dx.doi.org/10.1097/00007632-199012000-00008] [PMID: 2149206]
-24Burn SC, Ansorge O, Zeller R, Drake JM. Management of osteoblastoma and osteoid osteoma of the spine in childhood. J Neurosurg Pediatr 2009; 4(5): 434-8.
[http://dx.doi.org/10.3171/2009.6.PEDS08450] [PMID: 19877775]
]. Minimally invasive percutaneous image-guided techniques are preferred in young patients without previous neurological compromise and instability.

Fig. (1)
Preoperative MRI. (a) Axial T2-weighted magnetic resonance image shows the nidus (white harrow) surrounded by bone marrow oedema; (b) Sagittal T2W images points out the nidus and the perinidal sclerosis extending to the left pedicle of L5 vertebra; (c) the same lesion has low signal on T1-weighted images. (d)Technetium bone scan is useful to localize the lesion in the left posterior side of L5 vertebra).


Fig. (2)
Axial (a) and sagittal (b) unenhanced CT scan depicts the nidus of the osteoid osteoma at the superior facet joint of L5 vertebra as a small osteolytic lesion (diameter 8 mm) with surrounding osteosclerosis.


Fig. (3)
Percutaneous radiofrequency thermal ablation of the lesion.


Radiofrequency ablation CT-guided is the treatment of choice for small OOs, with a reported success rate of up to 90%, and a complication rate of less than 2% [6Laurence N, Epelman M, Markowitz RI, Jaimes C, Jaramillo D, Chauvin NA. Osteoid osteomas: a pain in the night diagnosis. Pediatr Radiol 2012; 42(12): 1490-501.
[http://dx.doi.org/10.1007/s00247-012-2495-y] [PMID: 23089877]
, 25De Filippo M, Russo U, Papapietro VR, et al. Radiofrequency ablation of osteoid osteoma. Acta Biomed 2018; 89(1-S): 175-85.
[PMID: 29350646]
]. Compared with the traditional surgical approach, RFA is more cost-effective, reduces the risk of blood loss and postoperative pain and does not generally require hospitalization. It can be performed in local anesthesia; rarely general or epidural anesthesia is required to avoid inadvertent movements of the patient. Indeed, the main drawback of this technique is the possibility of injury of surrounding structures, in particular for the spinal roots, that can range from nerve root irritation to transient or permanent neurological deficit. For this reason, the patient must be informed of the potential risks and benefits of the procedure. Recurrences (rate near to 5%), often within 6 months of treatment, due to incomplete ablation of the nidus, are described [4Jackson RP, Reckling FW, Mants FA. Osteoid osteoma and osteoblastoma. Similar histologic lesions with different natural histories. Clin Orthop Relat Res 1977; (128): 303-13.
[PMID: 598169]
]. Therefore, it is important to maintain a temperature of 90° for 5-6 minutes to guarantee a satisfactory ablation of the nidus [25De Filippo M, Russo U, Papapietro VR, et al. Radiofrequency ablation of osteoid osteoma. Acta Biomed 2018; 89(1-S): 175-85.
[PMID: 29350646]
]. CT is helpful to recognize and center the target, providing quick acquisition, thin slices, high-image resolution and the possibility of 3D reconstruction for preoperative planning [12Elefante A, Caranci F, Del Basso De Caro ML, et al. Paravertebral high cervical chordoma. A case report. Neuroradiol J 2013; 26(2): 227-32.
[http://dx.doi.org/10.1177/197140091302600214] [PMID: 23859247]
, 26de Divitiis O, Elefante A. Cervical spinal brucellosis: a diagnostic and surgical challenge. World Neurosurg 2012; 78(3-4): 257-9.
[http://dx.doi.org/10.1016/j.wneu.2012.01.050] [PMID: 22381861]
].

CONCLUSION

Spinal OO is a rare entity and its characteristic pain is often misinterpreted as radicular. No evidence of disc herniation or nerve root compression at MRI can guide to diagnosis.

Surgery is not suitable for young patients and should be reserved only in the case of preoperative neurological compromise or spinal deformity, such as in the case of OO-related scoliosis [27Zhang H, Niu X, Wang B, He S, Hao D. Scoliosis secondary to lumbar osteoid osteoma: A case report of delayed diagnosis and literature review. Medicine (Baltimore) 2016; 95(47)e5362
[http://dx.doi.org/10.1097/MD.0000000000005362] [PMID: 27893671]
].

Imaging-guided RFA is currently considered the treatment of choice but has a relative risk of thermal injury to the nerve roots, so proper preoperative planning has to be made and adequate informed consent must be obtained from the patient.

ABBREVIATION

OO  = Osteoid osteoma
NSAIDs  = Nonsteroidal anti-inflammatory drugs
RFA  = Radiofrequency ablation
MRI  = Magnetic resonance imaging
CT  = Computed tomography.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

Not applicable.

HUMAN AND ANIMAL RIGHTS

No animals/humans were used in the studies that is the the basis of this research.

CONSENT FOR PUBLICATION

Not applicable.

STANDARDS OF REPORTING

CARE guidelines and methodology have been followed.

FUNDING

None declared.

CONFLICT OF INTEREST

The authors declares no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declared none.

REFERENCES

[1] Jaffe HL. Osteoid-osteoma. Proc R Soc Med 1953; 46(12): 1007-12.
[PMID: 13120827]
[2] Janin Y, Epstein JA, Carras R, Khan A. Osteoid osteomas and osteoblastomas of the spine. Neurosurgery 1981; 8(1): 31-8.
[http://dx.doi.org/10.1227/00006123-198101000-00007] [PMID: 7207770]
[3] Kan P, Schmidt MH. Osteoid osteoma and osteoblastoma of the spine. Neurosurg Clin N Am 2008; 19(1): 65-70.
[http://dx.doi.org/10.1016/j.nec.2007.09.003] [PMID: 18156049]
[4] Jackson RP, Reckling FW, Mants FA. Osteoid osteoma and osteoblastoma. Similar histologic lesions with different natural histories. Clin Orthop Relat Res 1977; (128): 303-13.
[PMID: 598169]
[5] Gasbarrini A, Cappuccio M, Bandiera S, Amendola L, van Urk P, Boriani S. Osteoid osteoma of the mobile spine: surgical outcomes in 81 patients. Spine 2011; 36(24): 2089-93.
[http://dx.doi.org/10.1097/BRS.0b013e3181ffeb5e] [PMID: 21304430]
[6] Laurence N, Epelman M, Markowitz RI, Jaimes C, Jaramillo D, Chauvin NA. Osteoid osteomas: a pain in the night diagnosis. Pediatr Radiol 2012; 42(12): 1490-501.
[http://dx.doi.org/10.1007/s00247-012-2495-y] [PMID: 23089877]
[7] Ono T, Sakamoto A, Jono O, Shimizu A. Osteoid Osteoma Can Occur at the Pars Interarticularis of the Lumbar Spine, Leading to Misdiagnosis of Lumbar Spondylolysis. Am J Case Rep 2018; 19: 207-13.
[http://dx.doi.org/10.12659/AJCR.907438] [PMID: 29479057]
[8] Zenmyo M, Yamamoto T, Ishidou Y, Komiya S, Ijiri K. Osteoid osteoma near the intervertebral foramen may induce radiculopathy through tumorous inflammation. Diagn Pathol 2011; 6: 10.
[http://dx.doi.org/10.1186/1746-1596-6-10] [PMID: 21247497]
[9] Tomasian A, Wallace AN, Jennings JW. Benign Spine Lesions: Advances in Techniques for Minimally Invasive Percutaneous Treatment. AJNR Am J Neuroradiol 2017; 38(5): 852-61.
[http://dx.doi.org/10.3174/ajnr.A5084] [PMID: 28183835]
[10] Atesok KI, Alman BA, Schemitsch EH, Peyser A, Mankin H. Osteoid osteoma and osteoblastoma. J Am Acad Orthop Surg 2011; 19(11): 678-89.
[http://dx.doi.org/10.5435/00124635-201111000-00004] [PMID: 22052644]
[11] Maiuri F, Signorelli C, Lavano A, Gambardella A, Simari R, D’Andrea F. Osteoid osteomas of the spine. Surg Neurol 1986; 25(4): 375-80.
[http://dx.doi.org/10.1016/0090-3019(86)90214-4] [PMID: 3952633]
[12] Elefante A, Caranci F, Del Basso De Caro ML, et al. Paravertebral high cervical chordoma. A case report. Neuroradiol J 2013; 26(2): 227-32.
[http://dx.doi.org/10.1177/197140091302600214] [PMID: 23859247]
[13] Mariniello G, Napoli M, Russo C, et al. MRI features of spinal solitary fibrous tumors. A report of two cases and literature review. Neuroradiol J 2012; 25(5): 610-6.
[http://dx.doi.org/10.1177/197140091202500516] [PMID: 24029098]
[14] Mariniello G, Briganti F, De Caro ML, Maiuri F. Cervical extradural “en-plaque” meningioma. J Neurol Surg A Cent Eur Neurosurg 2012; 73(5): 330-3.
[http://dx.doi.org/10.1055/s-0032-1304222] [PMID: 22777927]
[15] Cocozza S, Russo C, Pontillo G, et al. Is advanced neuroimaging for neuroradiologists? A systematic review of the scientific literature of the last decade. Neuroradiology 2016; 58(12): 1233-9.
[http://dx.doi.org/10.1007/s00234-016-1761-3] [PMID: 27826667]
[16] Saracino D, D’Armiento FP, Conforti R, et al. Dramatic neurological debut in a case of Köhlmeier-Degos disease. Neurol Sci 2019; 40(10): 2201-3.
[http://dx.doi.org/10.1007/s10072-019-03952-x] [PMID: 31183675]
[17] Ozaki T, Liljenqvist U, Hillmann A, et al. Osteoid osteoma and osteoblastoma of the spine: experiences with 22 patients. Clin Orthop Relat Res 2002; (397): 394-402.
[http://dx.doi.org/10.1097/00003086-200204000-00046] [PMID: 11953633]
[18] Güzey FK, Seyithanoglu MH, Sencer A, Emei E, Alatas I, Izgi AN. Vertebral osteoid osteoma associated with paravertebral soft-tissue changes on magnetic resonance imaging. Report of two cases. J Neurosurg 2004; 100(5)(Suppl Pediatrics): 532-6.
[PMID: 15287469]
[19] Harish S, Saifuddin A. Imaging features of spinal osteoid osteoma with emphasis on MRI findings. Eur Radiol 2005; 15(12): 2396-403.
[http://dx.doi.org/10.1007/s00330-005-2816-8] [PMID: 15973540]
[20] Schmitz A, Diedrich O, Schmitt O. [Sacral osteoid osteoma--a rare cause of back pain in childhood and adolescence]. Klin Padiatr 2000; 212(3): 110-2.
[http://dx.doi.org/10.1055/s-2000-9662] [PMID: 10916781]
[21] Boretz RS, Lonner BS. Atypical presentation of an osteoid osteoma in a child. Am J Orthop 2002; 31(6): 347-8.
[PMID: 12083588]
[22] Nemoto O, Moser RP Jr, Van Dam BE, Aoki J, Gilkey FW. Osteoblastoma of the spine. A review of 75 cases. Spine 1990; 15(12): 1272-80.
[http://dx.doi.org/10.1097/00007632-199012000-00008] [PMID: 2149206]
[23] Zileli M, Cagli S, Basdemir G, Ersahin Y. Osteoid osteomas and osteoblastomas of the spine. Neurosurg Focus 2003; 15(5)E5
[http://dx.doi.org/10.3171/foc.2003.15.5.5] [PMID: 15323462]
[24] Burn SC, Ansorge O, Zeller R, Drake JM. Management of osteoblastoma and osteoid osteoma of the spine in childhood. J Neurosurg Pediatr 2009; 4(5): 434-8.
[http://dx.doi.org/10.3171/2009.6.PEDS08450] [PMID: 19877775]
[25] De Filippo M, Russo U, Papapietro VR, et al. Radiofrequency ablation of osteoid osteoma. Acta Biomed 2018; 89(1-S): 175-85.
[PMID: 29350646]
[26] de Divitiis O, Elefante A. Cervical spinal brucellosis: a diagnostic and surgical challenge. World Neurosurg 2012; 78(3-4): 257-9.
[http://dx.doi.org/10.1016/j.wneu.2012.01.050] [PMID: 22381861]
[27] Zhang H, Niu X, Wang B, He S, Hao D. Scoliosis secondary to lumbar osteoid osteoma: A case report of delayed diagnosis and literature review. Medicine (Baltimore) 2016; 95(47)e5362
[http://dx.doi.org/10.1097/MD.0000000000005362] [PMID: 27893671]
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J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


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