We made a 3-cm incision on the lateral side of the left rectal abdominis muscle to allow both placement of the reference antenna of the navigation system on the superior anterior iliac spine and collection of bone for grafting from the iliac crest. Therefore, we opted to perform a minimally invasive surgery via an approach normally used for lateral interbody fusion (LIF) and used a CT navigation system. Moreover, given that the patient was an elite athlete, we needed to devise a minimally invasive strategy to minimize the risk of iatrogenic injury to the muscles, bones, and joints. Coronal and axial bone scintigraphy images (C) showing a focal accumulation of increased activity in the anterior portion of the L4 vertebral body (arrowhead).Ĭonsidering that the tumor was very small and was located on the ventral side of the vertebral body, we anticipated difficulty in performing a biopsy concurrent with complete removal via a transpedicular approach. 2C).Īnteroposterior (A) and lateral (B) X-ray images. A bone scintigraphy image demonstrated a focal accumulation of increased activity in the anterior portion of the L4 vertebral body that appeared to be associated with the tumor ( Fig. Sagittal short tau inversion recovery magnetic resonance images showed inflammatory changes around the tumor ( Fig. However, computed tomography (CT) scans revealed a lesion with a heterogeneous enhancement pattern that was surrounded by calcification (i.e., the nidus of osteoid osteoma) in the anterior vertebral body at L4 ( Fig. Neurologic examinations and laboratory investigations were deemed normal. ![]() Thus, at this point, he was referred to us for surgery.Īt the first visit, his low back pain was triggered when bending forward. However, the effect of the medication waned, and his pain worsened over time to the point that he could no longer participate in sports training. His night pain was relieved immediately by a non-steroidal anti-inflammatory drug. A subsequent medical examination revealed an osteoid osteoma in the anterior portion of the L4 vertebra. When his low back pain worsened, he was diagnosed as having a lumbar vertebral stress fracture. ![]() A 20-year-old male winter sports athlete presented with a 2-year history of chronic low back pain that had started during sports practice and was worse at nighttime.
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