Full-endoscopic pedicle-based approach for resection of osteoid osteoma in the lumbar spine - a case report and review of current literature

Sep 30, 2026

Full-endoscopic pedicle-based resection is evaluated for spinal osteoid osteoma (OO), a rare benign tumor that can cause severe pain and radiculopathy, especially when involving posterior elements such as the pedicle. The report describes a 20-year-old woman with progressive low back pain and left L5 radiculopathy whose imaging showed a nidus in the left L5 pedicle. Using a full-endoscopic pedicle-based technique under fluoroscopy with RIWOspine, the nidus was completely excised, symptoms resolved immediately, and follow-up confirmed no recurrence or instability. A literature review supports the approach as a minimally invasive option, while larger standardized studies remain needed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction

Case Description

Conclusions

Key findings

What is known and what is new?

What is the implication, and what should change now?

Full-endoscopic pedicle-based approach for resection of osteoidosteoma in the lumbar spine: a case report and review of current literature Wongthawat Liawrungrueang1^, Watcharaporn Cholamjiak2^, Sompoom Sunpaweravong3^, Peem Sarasombath4^ 1Department of Orthopaedics, School of Medicine, University of Phayao, Phayao, Thailand; 2Department of Mathematics, School of Science, University of Phayao, Phayao, Thailand; 3Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; 4Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand Contributions: (I) Conception and design: W Liawrungrueang, P Sarasombath; (II) Administrative support: W Liawrungrueang, P Sarasombath, S Sunpaweravong; (III) Provision of study materials or patients: W Liawrungrueang, P Sarasombath; (IV) Collection and assembly of data: W Liawrungrueang, P Sarasombath; (V) Data analysis and interpretation: W Liawrungrueang, P Sarasombath, W Cholamjiak; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Peem Sarasombath, MD. Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Rd., Thung Phaya Thai, Ratchathewi, Bangkok 10400, Thailand. Email: [peems13063@gmail.com](peems13063@gmail.com); Watcharaporn Cholamjiak, PhD. Department of Mathematics, School of Science, University of Phayao, 19 Moo 2 Tambon Maeka Amphur Muang Phayao, Phayao 56000, Thailand. [Email: watcharaporn.ch@up.ac.th](Email: watcharaporn.ch@up.ac.th). Background: Osteoid osteoma (OO) of the spine is a rare benign tumor that can cause significant pain and radiculopathy, particularly when the lesion involves the posterior elements such as the pedicle. Although traditional treatments like radiofrequency ablation (RFA) and open surgery are effective, they pose risks including neural injury and spinal instability. In recent years, full-endoscopic spine surgery has emerged asa minimally invasive alternative, offering precise lesion localization and resection while preserving spinal integrity. Case Description: We present the case of a 20-year-old female who reported a 6-month history of progressive low back pain and severe left-sided L5 radiculopathy. Imaging revealed a nidus in the left L5 pedicle consistent with OO. The lesion was successfully resected using a full-endoscopic pedicle-based approach with the RIWOspine system. The procedure was performed under fluoroscopic guidance, allowing direct visualization and excision of the nidus. The patient experienced immediate symptom relief, and postoperative imaging confirmed complete resection. Histopathological examination confirmed the diagnosis of OO. At 1-year follow-up, she remained asymptomatic with no evidence of recurrence or spinal instability. Conclusions: Full-endoscopic pedicle-based resection provides a safe, effective, and minimally invasive technique for managing spinal OOs. This approach offers direct nidus visualization, preservation of spinal stability, and excellent clinical outcomes, supporting its utility as a preferred option in select cases. A literature review further supports its utility as a viable first-line surgical option, particularly in young patients with posterior element lesions. Future studies are needed to validate this technique in larger cohorts and to establish standardized protocols. Keywords: Osteoid osteoma (OO); lumbar spine; full-endoscopic surgery; pedicle-based approach; case report ^ ORCID: Wongthawat Liawrungrueang, 0000-0002-4491-6569; Watcharaporn Cholamjiak, 0000-0002-8563-017X; Sompoom Sunpaweravong, 0009-0009-5550-3995; Peem Sarasombath, 0000-0003-0513-238X. © AME Publishing Company. J Spine Surg 2025;11(4):1167-1174 | [https://dx.doi.org/10.21037/jss-25-59](https://dx.doi.org/10.21037/jss-25-59) 1168 Liawrungrueang et al. Full-endoscopic spinal OO Submitted Apr 11, 2025. Accepted for publication Jul 0

FAQs

What clinical problem does the document address?

It addresses osteoid osteoma (OO) of the lumbar spine, particularly cases involving posterior elements like the pedicle that can produce significant pain and radiculopathy.

How was the case treated and confirmed?

The left L5 pedicle nidus was resected using a full-endoscopic pedicle-based approach (RIWOspine) under fluoroscopic guidance. Postoperative imaging confirmed complete nidus excision and histopathology confirmed OO.

What conclusions does the document draw about the technique?

Full-endoscopic pedicle-based resection is presented as safe, effective, minimally invasive, and supportive of preserved spinal stability, with literature review indicating favorable outcomes, while future larger studies are needed for standardized protocols.

Sep 30, 2026

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