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Background: Osteoid osteomas (OOs) are benign bone forming tumors that, usually, occur in the extremities, with about 10% of them arising in the spine more commonly in the posterior elements. The aim of this study is to evaluate the long-term results of patients suffering from spinal OO treated with surgery and radiofrequency ablation., Methods: This was a retrospective comparison analysis of data prospectively collected from 2 cohorts of consecutive patients diagnosed with OO of the spine treated at the same Institute from November 2002 to February 2019. The first cohort included patients submitted to an intralesional extracapsular excision of the lesion (surgery group); the second cohort included patients submitted to radiofrequency ablation (RFA group)., Results: The surgery group showed a local recurrence rate of 1.7% versus a recurrence rate of 12.5% in the RFA group with a statistically significant difference in the disease-free survival at longest follow-up (P = 0.012). No statistically significant differences were observed in local recurrence rate stratified for level and site of lesion. No complications were observed in both groups at the time of first procedure., Conclusions: Surgery and RFA are both safe and effective interventional procedures for the management of spinal OO, although RFA is associated with a greater recurrence rate. Treatment should be tailored according to the relationship of lesions with neural structures and to advantages and disadvantages of each technique., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Nonoperative management is currently the preferred method of treatment for osteoid osteoma by some orthopedic surgeons. The follow-up imaging appearance of osteoid osteoma in patients who are managed conservatively has not previously been described in radiology literature, and it is unclear what the natural evolution of the imaging findings is. Such patients may present to the radiologist either for follow-up assessment of the lesion or as an incidental finding during imaging for an unrelated complaint. The magnetic resonance imaging (MRI) findings in two patients with osteoid osteoma who underwent conservative treatment are presented.